"Changes in PCI market share between DES and BMS have been previously reported among selected subsets of U.S. hospitals, and these changes possibly reflect a high level of clinician enthusiasm for DES in the years immediately following US Food and Drug Administration approval," the authors wrote.
But that enthusiasm was "followed by a 'cooling off' period after publication of data suggesting DES safety concerns (such as late in-stent thrombosis), as well as increasing clinician awareness of the imperative for DES patients’ adherence to long-duration anti-platelet therapy following DES implantation."
They added, "An important implication of this volatility is that thousands of patients may have received DES during the peak years (2004-2005) who would have instead received BMS in 2007-2008. Whether these patients were appropriately treated with DES instead of BMS during these years of high enthusiasm for DES is uncertain."
Interestingly, the number of hospitals performing CABG procedures increased dramatically signaling that greater numbers of patients "were obtaining CABG surgery at hospitals with low volumes of CABG surgery," they wrote. "Although there is controversy in the literature on whether low income hospitals inherently have worse CABG surgery outcomes, our findings highlight the increasing role of low-volume hospitals in the provision of CABG surgery."
The data were taken from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project sample of 1,000 hospitals and extrapolated the entire U.S. healthcare system.