Cost-Effectiveness Study in the Reduction of Coronary Restenosis With Sirolimus-Eluting Stents

Study Overview
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Brief Summary
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Since the advent of coronary stents, in-stent restenosis has proven to be the major limitation of interventional cardiology, occurring in as many as 30% of patients. Drug-eluting stents are specifically designed to prevent the problem of in-stent restenosis. They consist of a selective anti-proliferative drug, sirolimus, a controlled-release polymer, and a closed-cell stent delivery platform. Upon placement, sirolimus elutes into the vessel wall and stops the process of neointimal hyperplasia, thereby significantly reducing the incidence of in-stent restenosis. The study Prevention of Coronary Restenosis examines the effectiveness of sirolimus-eluting stents (SES) compared to bare-metal stents (BMS) in patients with coronary stenosis. The goal of the study is to examine whether the guideline-supported implantation of SES, despite the higher initial cost, improves the quality and economic outcomes of the treatment of patients with coronary stenosis. Secondarily, the study evaluates patient quality of life, impairment of daily activities, re-intervention rate, as well as an account of the utilisation and benefits of the implemented standardised guidelines. In this prospective, multi-centre, country-wide cohort study, 658 patients undergoing an implantation of a SES for treatment of coronary stenosis were recruited from 35 hospital centres. Their treatment and outcomes will be evaluated over a 3-year period by means of standardised questionnaires. In addition, information obtained from the patients will be confirmed and augmented by telephone interviews with the attending physicians involved in their follow-up care. In order to appraise the effect of the new therapy, a comparison cohort group of 394 patients receiving a BMS was recruited. These patients will be evaluated and observed by the same method as those patients receiving a drug-eluting stent, also over 3 years

Official Title
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Model Project for the Reduction of Coronary Restenosis

Conditions
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Coronary Artery Disease

Intervention / Treatment
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* Device: bare metal stent
* Device: Cypher-Stent (Implantation of a sirolimus-eluting stent)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: indication for implantation of a coronary stent de novo lesions < or = 30 mm in patients with diabetes de novo lesions 12-30 mm or RVD 2.5-3.00 mm in patients without diabetes Exclusion Criteria: acute MI lesion length >30 mm in-stent restenosis distal lesion in RVD < 2.25 mm lesion in left main or bypass vessel contraindication to Clopidogrel

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Allocation: Non-Randomized


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: BMS<br>Implantation of a bare metal stent | Device: bare metal stent<br>* implantation of a bare metal stent<br>|
| Other: SES<br>Implantation of a sirolimus-eluting stent | Device: Cypher-Stent (Implantation of a sirolimus-eluting stent)<br>* Implantation of a sirolimus-eluting stent<br>* Other names: Cypher-Stent;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cost equivalence of sirolimus-eluting coronary stents versus bare metal stents |  | 3,6,12,18,24, 36 months following stent implantation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MACE (re-PCI, myocardial infarction, CABG, death) |  | 3,6,12,24,36 months after stent implantation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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drug-eluting stents