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Can the hospital management decide the type of stent to be put in a patient?

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Dr KK Aggarwal and Ms Ira Gupta    26 April 2018

No, the hospital management cannot decide the type of stent to be put in a patient. Informed consent is the rule for any procedure and it includes consent about the procedure, implant or devise and risk vs benefits. The doctor’s job is to enlist the options along with risk and benefits and let the patient be a part of the decision-making. For example, a recent meta-analysis has shown that cobalt-chromium everolimus-eluting stents are the best in an ST-elevation myocardial infarction (STEMI). Not giving this option may amount to malpractice.

Study: Second-generation cobalt-chromium everolimus-eluting stents are the best stents for patients with STEMI, according to a new meta-analysis published in J Am Coll Cardiol 2013;62(6):496-504. These stents represent a substantial advance in terms of both patient safety and efficacy compared to both bare-metal stents (BMS) and first-generation (drug-eluting stents).

The meta-analysis included 22 trials with 12,453 randomized patients who received sirolimus-eluting stents, paclitaxel-eluting stents, the Endeavor phosphorylcholine-based zotarolimus-eluting stent or the Xience cobalt-chromium everolimus-eluting stent (the only second-generation drug-eluting stent evaluated).

At 1 year, compared to bare-metal stents, the cobalt-chromium everolimus-eluting stent was associated with significantly lower rates of cardiac death/myocardial infarction (odds ratio [OR] 0.65), myocardial infarction (OR 0.55), definite stent thrombosis (OR 0.32) and definite/probable stent thrombosis (OR 0.36) and the sirolimus-eluting stents were associated with significantly lower rates of cardiac death/myocardial infarction (OR 0.70).

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