EDITORIAL

Intracoronary stenting: developments since the NICE report

A H Gershlick

Correspondence to:
Correspondence to:
Dr Anthony H Gershlick, University of Leicester School of Medicine, Clinical Sciences Wing, Glenfield General Hospital, Leicester LE3 9QP, UK;
agershlick@aol.com

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Stenting has become standard treatment for patients undergoing percutaneous coronary intervention. Clinical impressions continue to support this as a user friendly, safe, and efficacious technology

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Keywords: stents; National Institute for Clinical Excellence; NICE; glyocoprotein Iib/IIIa inhibitors

Abbreviations: ADMIRAL, abciximab before direct angioplasty and stenting in myocardial infarction regarding acute and long-term follow-up; AMIST, angioplasty versus minimally invasive surgery trial; ANAES, Agence Nationale d'Accreditation et d'Evaluation en Sante; ARTS, arterial revascularization therapy study; BESMART, Bestent in small arteries; CABG, coronary artery bypass graft; CADILLAC, controlled abciximab and device investigation to lower late angioplasty complications; ELUTES, evaluation of taxol eluting stent trial; EPISTENT, evaluation of platelet GP IIb/IIIa inhibitor for stenting; ESPRIT, European study of prevention of reocclusion after initial thrombolysis; HTA, health and technology assessment; INHIBIT, inhibit restenosis intervention with ß radiation trial; ISAR-SMART, intracoronary stenting or angioplasty for restenosis reduction in small arteries; LMS, left main stem; LVEF, left ventricular ejection fraction; MACE, major adverse cardiac event; MI, myocardial infarction; NICE, National Institute for Clinical Excellence; RAP, restenosis en arterias pequenas; RAVEL, randomized study with sirolimus coated BX velocity balloon expandable stent in the treatment of patients with de novo native coronary lesions; RCT, randomised controlled trial; SAFER, saphenous vein graft angioplasty free of emboli randomized trial; SISA, stents in small arteries; SIRUS, sirolimus; SLIDE, selected lesion indication for direct stenting; SOS, stent or surgery; START, stents and radiation therapy trial; TARGET, do tirofiban and Reopro give similar efficacy outcomes trial; TIMI, thrombolysis in myocardial infarction; TLR, target lesion revascularisation; TVR, target vascularisation rate; ULTIMA, unprotected left main trunk intervention multi-center assessment; VBT, vascular brachytherapy

The National Institute for Clinical Excellence (NICE) was established in the light of a perceived need for a regulatory body to review the efficacy of existing and new treatments and to appraise technological developments. It was seen as being important for the following reasons: (1) there was and is slow uptake, even of innovations of perceived benefit; (2) judgements on the interpretation or significance of the evidence can be different in different parts of the country, resulting in variations in the access for patients to the new treatments with the widespread perception of inequity; (3) wasteful use of resources can occur when treatments are used outside the range in which they are clinically cost effective, at the expense of alternative uses of those resources which could give greater benefits to patients.

The key functions of NICE are technology appraisal of both new and existing interventions, in order to assess clinical . . . [Full text of this article]

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