One-year clinical results and total costs of drug-eluting stents implantation in multivessel coronary artery disease

Abstract

Objectives: One hundred and eleven consecutive patients with multivessel coronary artery disease treated with percutaneous coronary intervention with multiple drug-eluting stents were examined to investigate 1-year clinical results and initial and total costs.

Methods: Clinical and procedural characteristics, duration of hospital stay and 12-month follow-up events were considered. Real costs of multivessel percutaneous coronary intervention with multiple drug-eluting stents were calculated, including disposables, personnel, equipment depreciation and hospital stay, whereas medical resources consumption at 12 months were calculated as disease related group reimbursement tariffs.

Results: The patient population (69% males, mean age 65 +/- 10 years) presented mid to high-risk clinical and anatomical characteristics. The mean number of treated vessels was 2.36 per patient with 2.8 drug-eluting stents per patient. A complete revascularization was achieved in 70% of cases. In-hospital events were post-procedural non-Q myocardial infarction in 5.4% and two retroperitoneal haemorrhages. Post-procedural hospital stay was 2.5 +/- 2.3 days (mean total hospital stay = 5.3 +/- 3 days). At 12-month follow-up, total mortality and acute myocardial infarction incidence were 3.6% and 1.8%, respectively; only one patient (0.9%) presented subacute stent thrombosis at 3 months, which was treated by urgent re-percutaneous coronary intervention. Target vessel revascularization rate was 12.6% and the incidence of cumulative major adverse cardiac events was 15.3%. Initial hospital costs were 8992 euros +/- 2825 (5518 euros +/- 1098 for procedure and 3473 euros+/- 2347 for hospital stay); follow-up costs were 222 euros+/- 3087, leading to 12-month total costs of 10214 euros+/- 4184.

Conclusions: Multivessel percutaneous coronary intervention with drug-eluting stents showed good early and medium-term results with acceptable total costs. Despite not completely being covered by actual disease related group reimbursement, the initial and final costs were substantially lower than that of disease related group reimbursement for coronary artery bypass graft.