Description of coronary stents used in France in 2014 : study from the national health-insurance database

In coronary angioplasty, there is a strong trend to treat with drug-eluting stents to the detriment of bare-metal stents or bioactive stents while drug-eluting use for reimbursement by the French National Insurance is more restrictive. Our study was intended to describe coronary angioplasty practices in France in 2014 from French healthcare databases.

109 850 patients were included (age [mean±SD] : 68±12 years ; 24% women). For nearly three-quarters, coronary stenting was performed by a drug-eluting stent.During the hospital stay, an average of 1,1±0,2 angioplasty were conducted with 1,5±0,8 stents by patient. An ACS was the cause of hospitalization for 58% while there was no known history of coronary disease for 46%. A comorbidity was identified in up to 78 % of patients including hypertension (70%), dyslipidemia (53%), diabetes (27%), cardiac failure (7%), chronic obstructive pulmonary disease (7%) and 17% with active cancer; 15% at high risk of bleeding. Stenting with bare metal stents or bioactive stents (versus drug-eluting stents) was more frequent among patients aged 70 years or over (56,2% vs 41,9%), hospitalized for ACS (64,9% vs 56,3%), with cancer (21,3% vs 15,1%), with COPD (8,7% vs 6,1%), with heart failure (9,1% vs 6,2%) and under anticoagulant therapy (16,3% vs 6,5%) or with history of hospitalization for bleeding (9,3% vs 6,6%).

Most of coronary stents implanted are drug-eluting stents. Stented patients with no drug eluting stents are mainly characterized by a profile of high-risk bleeding and/or limited life expectancy. The medium term impact of this selection needs to be assessed.