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Catheter Cardiovasc Interv. 2017 Sep 1;90(3):357-363. doi: 10.1002/ccd.26946. Epub 2017 Feb 7.

Beyond restenosis: Patients' preference for drug eluting or bare metal stents.

Author information

1
Saint Luke's Mid America Heart Institute, Division of Cardiology, Kansas City, MO.
2
Division of Medicine, University of Missouri at Kansas City, Kansas City, Missouri.
3
e-Patient Dave LLC and Society for Participatory Medicine, Newburyport, MA.

Abstract

OBJECTIVES:

To assess patients' perspective about factors associated with stent choice.

BACKGROUND:

Drug eluting stents (DES) markedly reduce the risk of repeat percutaneous coronary intervention (PCI), but necessitate a longer duration of dual anti-platelet therapy (DAPT) as compared with bare metal stents (BMS). Thus, understanding patients' perspective about factors associated with stent choice is paramount.

METHODS:

Patients undergoing angiography rated, on a 10-point scale, the importance (1 = not important, 10 = most important) of avoiding repeat revascularization and avoiding the following potential DAPT drawbacks: bleeding/bruising, more pills/day, medication costs and delaying elective surgery. The factor, or group of factors, that was rated highest by each patient was identified.

RESULTS:

Among 311 patients, repeat revascularization was the single most important consideration to 14.4% of patients, while 20.6% considered avoiding one of the DAPT drawbacks as most important. Most patients (65%) considered avoiding at least one DAPT drawback as important as avoiding repeat revascularization. In no subgroup of patients did more than a quarter of patients prefer avoiding repeat revascularization above all other concerns. Among patients undergoing PCI, more than three quarters received a DES, regardless of their stated preferences (DES use among those most valuing DES benefits, avoiding DAPT drawbacks, or both equally were 78.7%, 86.2%, and 85.6%, respectively, P = 0.56).

CONCLUSION:

Most patients reported that avoiding DAPT drawbacks was as important as avoiding repeat revascularization. Eliciting patient preferences regarding stent type can enhance shared decision-making and allow physicians to better tailor stent choice to patients' goals and values.

TRIAL REGISTRATION:

Developing and Testing a Personalized Evidence-based Shared Decision-making Tool for Stent Selection (DECIDE-PCI). ClinicalTrials.gov Identifier: NCT02046902. URL: https://clinicaltrials.gov/ct2/show/NCT02046902 © 2017 Wiley Periodicals, Inc.

KEYWORDS:

dual anti-platelet therapy; patients’ preferences; percutaneous coronary intervention; shared decision-making

PMID:
28168845
PMCID:
PMC5771426
DOI:
10.1002/ccd.26946
[Indexed for MEDLINE]
Free PMC Article

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