Jeschke Elke, Searle Julia, Günster Christian, Baberg Henning Thomas, Dirschedl Peter, Levenson Benny, Malzahn Jürgen, Mansky Thomas, Möckel Martin
Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany.
Department of Cardiology and Division of Emergency Medicine and Chest Pain Units, Campus Virchow Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
BMJ Open. 2017 Jul 28;7(7):e017460. doi: 10.1136/bmjopen-2017-017460.
To describe the use of drug-eluting stents (DESs) in the largest population of statutory health insurance members in Germany, including newly developed bio-resorbable vascular scaffolds (BVSs), and to evaluate 1-year complication rates of DES as compared with bare metal stents (BMSs) in this cohort.
Routine data analysis of statutory health insurance claims data from the years 2008 to 2014.
The German healthcare insurance Allgemeine Ortskrankenkasse covers approximately 30% of the German population and is the largest nationwide provider of statutory healthcare insurance in Germany.
We included all patients with a claims record for a percutaneous coronary intervention (PCI) with either DES or BMS and additionally, from 2013, BVS. Patients with acute myocardial infarction (AMI) were excluded.
major adverse cerebrovascular and cardiovascular event (MACCE, defined as mortality, AMI, stroke and transient ischaemic attack), bypass surgery, PCI and coronary angiography) at 1 year after the intervention.
A total of 243 581 PCI cases were included (DES excluding BVS: 143 765; BVS: 1440; BMS: 98 376). The 1-year MACCE rate was 7.42% in the DES subgroup excluding BVS and 11.29% in the BMS subgroup. The adjusted OR for MACCE was 0.72 (95% CI 0.70 to 0.75) in patients with DES excluding BVS as compared with patients with BMS. In the BVS group, the proportion of 1-year MACCE was 5.0%.
The analyses demonstrate a lower MACCE rate for PCI with DES. BVSs are used in clinical routine in selected cases and seem to provide a high degree of safety, but data are still sparse.
描述药物洗脱支架（DES）在德国法定医疗保险参保人数最多的人群中的使用情况，包括新开发的生物可吸收血管支架（BVS），并评估该队列中DES与裸金属支架（BMS）相比的1年并发症发生率。
对2008年至2014年法定医疗保险理赔数据进行常规数据分析。
德国地方医疗保险（Allgemeine Ortskrankenkasse）覆盖约30%的德国人口，是德国最大的全国性法定医疗保险提供商。
我们纳入了所有有经皮冠状动脉介入治疗（PCI）使用DES或BMS的理赔记录的患者，此外，从2013年起纳入使用BVS的患者。排除急性心肌梗死（AMI）患者。
干预后1年的主要不良脑血管和心血管事件（MACCE，定义为死亡、AMI、中风和短暂性脑缺血发作）、搭桥手术、PCI和冠状动脉造影。
共纳入243581例PCI病例（不包括BVS的DES：143765例；BVS：1440例；BMS：98376例）。不包括BVS的DES亚组1年MACCE发生率为7.42%，BMS亚组为11.29%。与BMS患者相比，不包括BVS的DES患者MACCE的调整后比值比为0.72（95%CI 0.70至0.75）。在BVS组中，1年MACCE的比例为5.0%。
分析表明DES用于PCI时MACCE发生率较低。BVS在特定病例的临床常规中使用，似乎具有高度安全性，但数据仍然较少。
