Factors Associated With Off-Label Use of Drug-Eluting Stents in Patients With ST-Elevation Myocardial Infarction

Henry H. Ting, Matthew T. Roe, Bernard J. Gersh, John A. Spertus, John S. Rumsfeld, Fang-Shu Ou, John Kao, Kirsten Hall Long, David Holmes, Eric D. Peterson

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Drug-eluting stents (DESs) are used in >80% of percutaneous coronary intervention (PCI) procedures; however, up to 2/3 are used for off-label indications. Factors associated with DES use in patients with ST-elevation myocardial infarction (STEMI) are not known in contemporary clinical practice. We analyzed temporal trends, geographic patterns, and sociodemographic factors associated with off-label use of DESs in patients undergoing primary PCI for STEMI from July 2004 to March 2006 in the National Cardiovascular Data Registry (NCDR). The main outcome of this study was receipt of any DES, and the candidate independent variables were sociodemographic, hospital, clinical, and procedural variables. We also analyzed temporal trends and geographic patterns for use of DESs. A total of 30,235 patients with STEMI underwent primary PCI with use of DESs (84%) or bare metal stents (16%). Adoption of DESs was rapid but varied widely as a function of geographic location. After adjusting for clinical and procedural variables, older age was associated with lower use (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.91 to 0.98), whereas white race (OR 1.14, 95% CI 1.03 to 1.27), commercial insurance (OR 1.22, 95% CI 1.11 to 1.34), and the west census region (OR 1.37, 95% CI 1.04 to 1.81) were associated with higher use of DESs. In conclusion, adoption of DESs was rapid in patients with STEMI, but geographic location and sociodemographic and hospital factors were associated with the use DESs.

Original languageEnglish (US)
Pages (from-to)286-292
Number of pages7
JournalAmerican Journal of Cardiology
Volume101
Issue number3
DOIs
StatePublished - Feb 1 2008

Fingerprint

Off-Label Use
Drug-Eluting Stents
Percutaneous Coronary Intervention
Odds Ratio
Confidence Intervals
Geographic Locations
ST Elevation Myocardial Infarction
Censuses
Insurance
Stents
Registries
Metals
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Factors Associated With Off-Label Use of Drug-Eluting Stents in Patients With ST-Elevation Myocardial Infarction. / Ting, Henry H.; Roe, Matthew T.; Gersh, Bernard J.; Spertus, John A.; Rumsfeld, John S.; Ou, Fang-Shu; Kao, John; Long, Kirsten Hall; Holmes, David; Peterson, Eric D.

In: American Journal of Cardiology, Vol. 101, No. 3, 01.02.2008, p. 286-292.

Research output: Contribution to journalArticle

Ting, Henry H. ; Roe, Matthew T. ; Gersh, Bernard J. ; Spertus, John A. ; Rumsfeld, John S. ; Ou, Fang-Shu ; Kao, John ; Long, Kirsten Hall ; Holmes, David ; Peterson, Eric D. / Factors Associated With Off-Label Use of Drug-Eluting Stents in Patients With ST-Elevation Myocardial Infarction. In: American Journal of Cardiology. 2008 ; Vol. 101, No. 3. pp. 286-292.
@article{8d3a85b0af144ad089695146b0502626,
title = "Factors Associated With Off-Label Use of Drug-Eluting Stents in Patients With ST-Elevation Myocardial Infarction",
abstract = "Drug-eluting stents (DESs) are used in >80{\%} of percutaneous coronary intervention (PCI) procedures; however, up to 2/3 are used for off-label indications. Factors associated with DES use in patients with ST-elevation myocardial infarction (STEMI) are not known in contemporary clinical practice. We analyzed temporal trends, geographic patterns, and sociodemographic factors associated with off-label use of DESs in patients undergoing primary PCI for STEMI from July 2004 to March 2006 in the National Cardiovascular Data Registry (NCDR). The main outcome of this study was receipt of any DES, and the candidate independent variables were sociodemographic, hospital, clinical, and procedural variables. We also analyzed temporal trends and geographic patterns for use of DESs. A total of 30,235 patients with STEMI underwent primary PCI with use of DESs (84{\%}) or bare metal stents (16{\%}). Adoption of DESs was rapid but varied widely as a function of geographic location. After adjusting for clinical and procedural variables, older age was associated with lower use (odds ratio [OR] 0.94, 95{\%} confidence interval [CI] 0.91 to 0.98), whereas white race (OR 1.14, 95{\%} CI 1.03 to 1.27), commercial insurance (OR 1.22, 95{\%} CI 1.11 to 1.34), and the west census region (OR 1.37, 95{\%} CI 1.04 to 1.81) were associated with higher use of DESs. In conclusion, adoption of DESs was rapid in patients with STEMI, but geographic location and sociodemographic and hospital factors were associated with the use DESs.",
author = "Ting, {Henry H.} and Roe, {Matthew T.} and Gersh, {Bernard J.} and Spertus, {John A.} and Rumsfeld, {John S.} and Fang-Shu Ou and John Kao and Long, {Kirsten Hall} and David Holmes and Peterson, {Eric D.}",
year = "2008",
month = "2",
day = "1",
doi = "10.1016/j.amjcard.2007.09.084",
language = "English (US)",
volume = "101",
pages = "286--292",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Factors Associated With Off-Label Use of Drug-Eluting Stents in Patients With ST-Elevation Myocardial Infarction

AU - Ting, Henry H.

AU - Roe, Matthew T.

AU - Gersh, Bernard J.

AU - Spertus, John A.

AU - Rumsfeld, John S.

AU - Ou, Fang-Shu

AU - Kao, John

AU - Long, Kirsten Hall

AU - Holmes, David

AU - Peterson, Eric D.

PY - 2008/2/1

Y1 - 2008/2/1

N2 - Drug-eluting stents (DESs) are used in >80% of percutaneous coronary intervention (PCI) procedures; however, up to 2/3 are used for off-label indications. Factors associated with DES use in patients with ST-elevation myocardial infarction (STEMI) are not known in contemporary clinical practice. We analyzed temporal trends, geographic patterns, and sociodemographic factors associated with off-label use of DESs in patients undergoing primary PCI for STEMI from July 2004 to March 2006 in the National Cardiovascular Data Registry (NCDR). The main outcome of this study was receipt of any DES, and the candidate independent variables were sociodemographic, hospital, clinical, and procedural variables. We also analyzed temporal trends and geographic patterns for use of DESs. A total of 30,235 patients with STEMI underwent primary PCI with use of DESs (84%) or bare metal stents (16%). Adoption of DESs was rapid but varied widely as a function of geographic location. After adjusting for clinical and procedural variables, older age was associated with lower use (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.91 to 0.98), whereas white race (OR 1.14, 95% CI 1.03 to 1.27), commercial insurance (OR 1.22, 95% CI 1.11 to 1.34), and the west census region (OR 1.37, 95% CI 1.04 to 1.81) were associated with higher use of DESs. In conclusion, adoption of DESs was rapid in patients with STEMI, but geographic location and sociodemographic and hospital factors were associated with the use DESs.

AB - Drug-eluting stents (DESs) are used in >80% of percutaneous coronary intervention (PCI) procedures; however, up to 2/3 are used for off-label indications. Factors associated with DES use in patients with ST-elevation myocardial infarction (STEMI) are not known in contemporary clinical practice. We analyzed temporal trends, geographic patterns, and sociodemographic factors associated with off-label use of DESs in patients undergoing primary PCI for STEMI from July 2004 to March 2006 in the National Cardiovascular Data Registry (NCDR). The main outcome of this study was receipt of any DES, and the candidate independent variables were sociodemographic, hospital, clinical, and procedural variables. We also analyzed temporal trends and geographic patterns for use of DESs. A total of 30,235 patients with STEMI underwent primary PCI with use of DESs (84%) or bare metal stents (16%). Adoption of DESs was rapid but varied widely as a function of geographic location. After adjusting for clinical and procedural variables, older age was associated with lower use (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.91 to 0.98), whereas white race (OR 1.14, 95% CI 1.03 to 1.27), commercial insurance (OR 1.22, 95% CI 1.11 to 1.34), and the west census region (OR 1.37, 95% CI 1.04 to 1.81) were associated with higher use of DESs. In conclusion, adoption of DESs was rapid in patients with STEMI, but geographic location and sociodemographic and hospital factors were associated with the use DESs.

UR - http://www.scopus.com/inward/record.url?scp=38549162280&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38549162280&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2007.09.084

DO - 10.1016/j.amjcard.2007.09.084

M3 - Article

C2 - 18237586

AN - SCOPUS:38549162280

VL - 101

SP - 286

EP - 292

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 3

ER -