Temporal trends in the use of drug-eluting stents for approved and off-label indications: A longitudinal analysis of a large multicenter percutaneous coronary intervention registry

Background: We sought to examine the temporal variations in the rate of both bare-metal stent (BMS) and drug-eluting stent (DES) use for off-label indications after the reports of an increased risk of very late stent thrombosisin patientswith DES atthe 2006 meetingof the EuropeanSocietyof Cardiology (ESC). Hypothesis: To determinewhetherthe decreasein use of DES has affectedboth onand off-label indications. Methods: The study cohort included patients undergoing coronary intervention in a large regional registry, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Patientdemographic and clinical characteristics for patients with DES in the third quarter of 2006 (pre-ESC) were compared to those from the fourth quarter of 2008 (post-guideline changes). Use of DES for off-label indications, such as STsegment elevation myocardial infarction (STEMI), in-stent restenosis (ISR), and saphenous vein graft (SVG) interventions,were evaluated. Results: The overalldeployment of DES fell sharply from 83% pre-ESC to a plateauof 58% in the first quarter of 2008. This corresponded to a rise in BMS use, while angioplasty procedures stayed the same. The STEMI subgroup showed the most dramatic change, from 78% to only 36%. Off-label use in SVGs showed a similar trend,from74%to43%.Drug-elutingstentdeploymentforISRwaslessaffected,thoughitalsofell25%(from 79%‐56%).