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J Am Coll Cardiol, 2000; 36:395-403 © 2000 by the American College of Cardiology Foundation |
* State University of New York, University at Albany, Albany, New York, USA
Buffalo General Hospital, Buffalo, New York, USA
Mid-America Heart Institute, Kansas City, Missouri, USA
St. Joseph’s Hospital, Syracuse, New York, USA
# Boston University School of Medicine, Boston, Massachusetts, USA
Manuscript received October 28, 1999; revised manuscript received February 22, 2000, accepted April 5, 2000.
Reprint requests and correspondence: Dr. Edward L. Hannan, Professor and Chair, Department of Health Policy, Management, and Behavior, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, New York 12144-3456
elh03{at}health.state.ny.us
OBJECTIVES
We sought to compare patient outcomes for coronary stent placement and balloon angioplasty.
BACKGROUND
Since 1994, the number of patients treated only with balloon angioplasty has decreased nationally, whereas the use of coronary stents as an alternative has grown tremendously. The objectives of this study were to compare short- and long-term survival and subsequent revascularization rates for patients undergoing single-vessel balloon angioplasty and coronary stent placement.
METHODS
New York’s Coronary Angioplasty Registry was used to identify New York patients undergoing either balloon angioplasty or stent placement between July 1, 1994, and December 31, 1996. Statistical models were used to compare risk-adjusted short- and long-term survival and subsequent coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCIs).
RESULTS
No significant differences were found in adjusted in-patient mortality, but patients who had balloon angioplasty were, on average, 1.36 times more likely to have died at any time during the two-year period after the index procedure (p = 0.003). The adjusted in-patient CABG rate was significantly higher for balloon angioplasty (2.72% vs. 1.66%, p < 0.0001), and the adjusted two-year CABG rate was also significantly higher for balloon angioplasty (10.81% vs. 7.25%, p < 0.001). The adjusted two-year rate for subsequent PCIs was also significantly higher for balloon angioplasty (19.6% vs. 14.3%, p < 0.0001). Although measures were taken to eliminate or minimize the effect of selection bias, it should be noted that patients with stents were healthier at hospital admission than patients who had balloon angioplasty.
CONCLUSIONS
Stent placement is associated with significantly lower risk-adjusted long-term mortality, CABG and subsequent PCI rates, as compared with balloon angioplasty.
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