emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2022.6.2.1666emcardio-78Research ArticleОригинальные научные публикацииOriginal Scientific ResearchЭкономическая эффективность использования различных типов стентов при коррекции хронических окклюзий коронарных артерийCost-effectiveness of different types of stents in the correction of chronic total occlusionСтельмашокВ. И.StelmashokV.

Минск

Minsk

stelval@yandex.byРеспубликанский научно-практический центр «Кардиология»Republican Scientific and Practical Center of Cardiology2022230620256216661672Copyright © Стельмашок В.И., 20252025Стельмашок В.И.Stelmashok V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/78

Цель. Изучить экономическую эффективность использования различных типов стентов при коррекции хронических окклюзий (ХТО) коронарных артерий. Методы. В исследование включено 119 пациентов, которым в 2009–2012 годах была успешно выполнена реканализация ХТО коронарных артерий. Через 6,1±0,9 месяцев и 12,7±1,6 месяцев выполнялось контрольное обследование (коронарография, внутрисосудистое ультразвуковое исследование, оптическая когерентная томография). Анализировались негативные события (внутристентовые рестенозы и тромбозы), c учетом полученных данных выполнялась калькуляция прямых затрат, включающая стоимость имплантов, расходы на лечение рестенозов и тромбозов.Результаты. Внутристентовые рестенозы чаще (p < 0,05) регистрировались после имплантации IntrepideTM (в 57,1%) и Prolim® (в 47,4%), тогда как в местах установки стентов Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori® аналогичные события отмечены в 0–11,1% случаев. Достоверной разницы по частоте развития тромбозов между изучаемыми изделиями выявлено не было (p > 0,05). Исходя из полученных данных, используемые стенты были классифицированы как изделия с низкой частотой развития негативных событий (Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori®, группа НЧНС) и стенты с высокой частотой отмеченных исходов (IntrepideTM и Prolim®, группа ВЧНС).В группе лиц с НЧНС средняя стоимость используемых стентов составила 2155,1 долларов США. Рентгеноэндоваскулярная коррекция внутристентовых рестенозов была выполнена в 6,3% случаев, тромбозов – в 1,3%, усредненные прямые затраты на лечение одного пациента в течение 12,7±1,6 месяцев были равными 3906,4 долларам США.В группе с ВЧНС использовались более дешевые изделия (средняя стоимость – 1650,8 долларов США). Повторные чрескожные коронарные вмешательства по причине внутристентовых рестенозов были проведены в 52,5% случаев, одному пациенту (2,5%) с верифицированным тромбозом выполнена операция коронарного шунтирования. Усредненные прямые затраты на лечение одного пациента в течение 12,7±1,6 месяцев были равными 4993,5 долларам США, что превышало аналогичный показатель в группе НЧНС на 1087,1 долларов США.Заключение. Полученные данные свидетельствуют о суммарно более высоких финансовых затратах в течение 12,7±1,6 месячного периода наблюдения после имплантации в зонах ХТО коронарных артерий стентов IntrepideTM и Prolim®. Это подчеркивает важность использования в данных клинических случаях коронарных имплантов, имеющих подтвержденные минимальные риски развития внутристентовых рестенозов и тромбозов.

Aim. To study cost-effectiveness of different types of stents in the correction of chronic total occlusion (CTO).Methods. The study included 119 patients after successful coronary artery CTO recanalization in 2009–2012. After 6.1±0.9 months and 12.7±1.6 months a control examination was performed (coronary angiography, intravascular ultrasound, optical coherence tomography). Negative events (in-stent restenosis and thrombosis) were analyzed. Taking into account the obtained data, direct costs were calculated including the cost of implants, and the cost of restenosis and thrombosis treatment.Results. The highest frequency of in-stent restenosis (p < 0.05) was registered after IntrepideTM (in 57.1% cases) and Prolim® (in 47.4% cases) stent implantation while the similar events in cases of Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori® stent implantation were registered in 0–11.1% of cases. There weren’t differences in the thrombosis incidence between studied types of implants (p > 0.05). Based on the data obtained, the stents were classified as devices with low rate of adverse events (Taxus® Express 2, Xience V®/Xience Prime® LL, Endeavor® Resolute, Nobori® – LRAE group), and those with a high rate of restenosis and thrombosis (IntrepideTM and Prolim® – HRAE group).The average cost of stents in the LRAE group was 2155.1 US dollars. Endovascular correction of in-stent restenosis were performed in 6.3% of cases, thrombosis – in 1.3%, the average direct treatment cost per patient over 12.7±1.6 months totaled 3906.4 US dollars.In the HRAE group the cheaper devices were implanted (median cost was $1650.8). Repeated PCIs due to restenosis were performed in 52.5% of cases, one patient (2.5%) with verified thrombosis underwent CABG. The average direct treatment cost per patient over 12.7±1.6 months period was 4993.5 US dollars, which was $1,087.1 more than in the LRAE group.Conclusion. The obtained data indicate higher financial cost during 12.7± 1.6 months follow-up period after IntrepideTM and Prolim® stent implantation in the recanalized CTO areas. This emphasizes the impotance of using coronary stents with proven minimal risks of in-trastent restenosis and thrombosis in CTO cases.

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The authors declare that there are no conflicts of interest present.