NICE guidance - coronary artery stents in treatment of IHD

Summary points from the NICE guidance:

• where percutaneous coronary intervention (PCI) is the clinically appropriate procedure in patients with either stable or unstable angina, or acute myocardial infarction, coronary artery stents should be used routinely
• guidance specifically applies to the present clinical indications for PCI and excludes conditions that are adequately managed with standard drug therapy e.g. stable angina
• guidance also states that if it is clinically considered appropriate to undertake either coronary artery bypass grafting (CABG) or PCI then, all other things being equal, PCI should be chosen, despite the risk of restenosis being higher with PCI. This is because the procedure is less invasive, has a lower chance of death during operation and involves much shorter and less painful recuperation period
• in a partial update NICE state that (2):
  • drug-eluting stents are recommended for use in percutaneous coronary intervention for the treatment of coronary artery disease, within their instructions for use, only if:
    • the target artery to be treated has less than a 3-mm calibre or the lesion is longer than 15 mm, and
    • the price difference between drug-eluting stents and bare-metal stents is no more than £300
      
      

Reference:

• (1) NICE (October 2003). Coronary artery stents.
• (2) NICE (July 2008). Drug-eluting stents for the treatment of coronary artery disease).