Austin David, Oldroyd Keith G, Holmes David R, Rihal Charanjit S, Galbraith P Diane, Ghali William A, Legrand Victor, Taeymans Yves, McConnachie Alex, Pell Jill P
Department of Public Health and Health Policy, University of Glasgow, Glasgow, United Kingdom.
Am Heart J. 2009 Oct;158(4):576-84. doi: 10.1016/j.ahj.2009.07.033.
We aimed to analyze trends in drug-eluting stents (DES) use in four international health care and regulatory settings.
Accounts suggest a differential approach to DES internationally and recent reductions in use following reports of late stent thrombosis. Current studies of clinical practice are limited in their scope.
Data were pooled from angioplasty registries in Alberta (Canada), Belgium, Mayo Clinic (Rochester, MN), and Scotland (UK) that have routinely recorded consecutive patients treated since 2003. Trend analysis was performed to examine variations in DES use over time and by clinical subgroup.
A total of 178,504 lesions treated between January 2003 and September 2007 were included. In the Mayo Clinic Registry, rapid adoption to a peak of 91% DES use for all lesions by late 2004 was observed. In contrast, Alberta and Scotland showed delayed adoption with lower peak DES use, respectively, 56% and 58% of lesions by early 2006. Adoption of DES in Belgium was more gradual and peak use of 35% lower than other registries. Reductions in DES use were seen in all data sets during 2006, although this varied in absolute and relative terms and by clinical subgroup.
Adoption and use of DES showed wide variation in four countries. The determinants of use are complex, and it is likely that nonclinical factors predominate. Recent reductions in use may be as a consequence of publicity and concerns regarding late stent thrombosis. The optimum application of DES in clinical practice is unclear and is reflected in the degree of international variation demonstrated.
我们旨在分析在四个国际医疗保健和监管环境中药物洗脱支架（DES）的使用趋势。
有报道称国际上对DES的使用方法存在差异，且在晚期支架血栓形成的报告发布后，近期其使用量有所下降。目前关于临床实践的研究范围有限。
汇总了加拿大艾伯塔省、比利时、美国明尼苏达州罗切斯特市梅奥诊所和英国苏格兰的血管成形术登记处的数据，这些登记处自2003年起常规记录连续接受治疗的患者。进行趋势分析以研究DES使用随时间和临床亚组的变化。
纳入了2003年1月至2007年9月期间治疗的总共178,504个病变。在梅奥诊所登记处，观察到到2004年末所有病变的DES使用率迅速上升至峰值91%。相比之下，艾伯塔省和苏格兰的采用较晚，DES使用峰值较低，到2006年初分别为病变的56%和58%。比利时对DES的采用较为缓慢，峰值使用率比其他登记处低35%。2006年所有数据集中DES的使用均有所减少，尽管在绝对和相对方面以及临床亚组中存在差异。
DES的采用和使用在四个国家中存在很大差异。使用的决定因素很复杂，非临床因素可能占主导。近期使用量的减少可能是由于对晚期支架血栓形成的宣传和担忧。DES在临床实践中的最佳应用尚不清楚，这反映在所示的国际差异程度上。
