Austin D, Oldroyd KG, Holmes DR, Rihal CS, Galbraith PD, Ghali WA, Legrand V, Taeymans Y, McConnachie A, Pell JP, on behalf of the APPROACH Investigators, Belgian Working Group on Invasive Cardiology, Mayo Clinic PCI Registry, and Scottish Coronary Revascularisation Registry Glasgow, United Kingdom; Rochester, MN; Calgary, Canada; and Liege, and Gent, Belgium. Drug-eluting stents: A study of international practice. Am Heart J 2009;158:576-84.

Objective: We aimed to analyze trends in drug-eluting stents (DES) use in four international health care and
regulatory settings.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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. (Am Heart J 2009;158:576-84.)

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