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Paradigm shifts in cardiovascular medicine

David R. Holmes, Jr, MD, FACC^*,*, Brian G. Firth, MD, PhD, FACC and Douglas L. Wood, MD, FACC^*

^* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Cordis Corporation, Warren, New Jersey, USA

View larger version (20K): [in a new window]   Figure 1 (Bars on left) Rates of in-stent restenosis determined angiographically in two clinical trials: 1) in the randomized study with the sirolimus-eluting Bx VELOCITY stent (RAVEL), the difference in restenosis rates at six months between patients who had a sirolimus-eluting stent and patients who had a control stent was 26.6% (p < 0.001); and 2) in the sirolimus-eluting Bx VELOCITY stent (SIRIUS) trial, the difference in restenosis rates at eight months between patients who had a sirolimus-eluting stent and patients who had a control stent was 32.2% (p < 0.001). (Bars in middle) In-segment restenosis rates were higher than in-stent restenosis rates (8.9% vs. 3.2%). This was related to arterial narrowing adjacent to the stented segment. (Bars on right) Rates of clinically driven target lesion revascularization in two clinical trials: 1) in RAVEL, the difference in revascularization rates at 210 days between patients who had a sirolimus-eluting stent and patients who had a control stent was 13.6% (p < 0.0001); and 2) in SIRIUS, the difference in revascularization rates at 270 days between patients who had a sirolimus-eluting stent and patients who had a control stent was 12.5% (p < 0.001).

View larger version (23K): [in a new window]   Figure 2 National average base payments by Medicare for diagnosis-related groups (DRGs) 516 and 517 (bare-metal stents) and DRGs 526 and 527 (drug-eluting stents) in fiscal year 2003. The base payment is $200 more for DRG 516 and $450 more for DRG 517 than that in fiscal year 2002. AMI = acute myocardial infarction.

View larger version (21K): [in a new window]   Figure 3 Third-party payers for cardiovascular procedures.