Guideline:
Drug-eluting stents for the treatment of coronary artery disease
Bibliographic Source(s)
- National Institute for Health and Clinical Excellence (NICE). Drug-eluting stents for the treatment of coronary artery disease. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Jul. 48 p. (Technology appraisal guidance; no. 152).
Guideline Status
This is the current release of the guideline.
Guideline Category
Assessment of Therapeutic Effectiveness
Treatment
Intended Users
Advanced Practice Nurses
Nurses
Physician Assistants
Physicians
Guideline Objective(s)
To evaluate the clinical effectiveness and cost-effectiveness of drug-eluting stents for the treatment of coronary artery disease
Target Population
Adults with coronary artery disease undergoing percutaneous coronary intervention (PCI)
Interventions and Practices Considered
Drug-eluting stents (DES)
Major Outcomes Considered
- Clinical effectiveness
- Combined event rate (major adverse cardiac events target vessel failure) or event free survival
- Mortality (all cause and cardiac)
- Acute myocardial infarction
- Target lesion revascularization
- Target vessel revascularization
- Repeat revascularization (percutaneous coronary intervention [PCI]/stent other PCI or coronary artery bypass grafting [CABG])
- Adverse effects (thrombosis mal-absorption; incomplete stent apposition; device failures/defects)
- Angiographic binary restenosis
- Late loss
- Health-related quality of life
- Cost-effectiveness
Methods Used to Collect/Select Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
Note from the National Guideline Clearinghouse (NGC): The National Institute for Health and Clinical Excellence (NICE) commissioned an independent academic centre to perform a systematic literature review on the technology considered in this appraisal and prepare an assessment report. The assessment report for this technology appraisal was prepared by the Liverpool Reviews and Implementation Group University of Liverpool (see the "Availability of Companion Documents" field).
Identification of Evidence: Clinical Effectiveness and Cost-effectiveness
Search Strategy
The search incorporated a number of strategies. Search terms for electronic databases included a combination of index terms (e.g. STENTS and CORONARY DISEASE) and free text words (e.g. 'stent' and 'coronary').
No limitation was included on study type and therefore identification of clinical effectiveness and cost-effectiveness data were combined within the electronic searches.
The following electronic databases were searched for relevant published literature for the period from December 2002 to June 2005. Searching dated from the limit of the searches in the Assessment Group's previous assessment.
- CDSR (Cochrane Database of Systematic Reviews)
- CENTRAL (Cochrane Central Register of Controlled Trials)
- DARE (Database of Abstracts of Reviews of Effectiveness)
- EMBASE
- HTA database
- ISI Web of Science- Proceedings (Index to Scientific & Technical Proceedings)
- ISI Web of Science- Science Citation Index Expanded
- MEDLINE
- NHS EED (National Health Service Economic Evaluation Database)
In addition MEDLINE (using the PubMed interface) was searched again later in the assessment (spanning 1 March to 3 Aug 2005) in order to identify publications that might not have been indexed at the time of the main electronic searching. Details of the search strategies and the number of references retrieved for each search are provided in Appendix 1 of the Assessment Report (see the "Availability of Companion Documents" field).
Reference lists of included studies and device manufacturer submissions were searched to identify other relevant studies of clinical effectiveness costs or cost-effectiveness.
Handsearching of cardiology conference abstracts was conducted. Latest conference proceedings for the following meetings were obtained for the purposes of handsearching:
- American College of Cardiology
- American Heart Association
- British Cardiac Society
- European Society of Cardiology
- Transcatheter Cardiovascular Therapeutics
Internet resources were examined for information on clinical studies and cost data. These included the following:
- Cardiovascular Revascularization Therapies (www.crtonline.org)
- The heart.org (www.theheart.org)
- Transcatheter Cardiovascular Therapeutics (www.tctmd.com)
All the references were exported to an EndNote bibliographic database Thomson ISI ResearchSoft Cal. USA.
Selection of Clinical Effectiveness and Cost-Effectiveness Evidence
The records identified in the electronic searches were assessed for inclusion in two stages. Firstly pairs of reviewers independently scanned all the titles and abstracts and identified the potentially relevant articles to be retrieved. Any differences in selection choice were discussed between the pairs and consensus reached in all cases. Full text reports of these selected papers were then obtained and assessed independently by at least two reviewers for inclusion. The inclusion/exclusion assessment of each reviewer was recorded on a pre-tested standardised form. Data on levels of agreement between reviewers is available from the Assessment Group upon request.
A table summarising the selection and inclusion of studies is provided in the Appendix 1 of the Assessment Report (see the "Availability of Companion Documents" field).
Methods for Reviewing Clinical Effectiveness
Inclusion Criteria
Studies were considered eligible for inclusion if they met the following criteria:
Study Design
- Randomised controlled trials (RCTs); non-randomised controlled trials (such as prospective registries); non-controlled studies (except case reports of single patient experience).
Population
- Adults with coronary artery disease (CAD) undergoing treatment of native and intervention naïve vessel(s) by percutaneous coronary intervention (PCI) with the use of stent(s).
Intervention
- Drug-eluting coronary artery stents which were expected to be available for use by the NHS close to the time of the assessment.
Comparators
- Drug-eluting stent (DES) versus non drug-eluting bare-metal stent (BMS)
- DES of different design (i.e. DES versus DES).
Outcomes
Studies were included in the clinical review if they reported primary data on one or more of the following outcomes:
- Combined event rate (major adverse cardiac events [MACE] target vessel failure [TVF]) or event free survival
- Mortality (all cause cardiac)
- Acute myocardial infarction (AMI)
- Target lesion revascularisation (TLR)
- Target vessel revascularisation (TVR)
- Repeat revascularisation (PCI/stent other PCI or coronary artery bypass grafting [CABG])
- Adverse effects (thrombosis mal-absorption; incomplete stent apposition; device failures/defects)
- Angiographic binary restenosis
- Late loss
- Health-related quality of life
Exclusion Criteria
Studies were excluded based on the following criteria:
- Single case reports
- Randomised controlled trials (RCTs) that:
- Provided only unplanned interim findings
- Provided data on only a sub-group of the enrolled patients
- Were continuing to recruit patients
- Where patients numbers treated with specific intervention (i.e. a particular type of stent) could not be determined
- Studies of:
- Treatment of in-stent restenosis
- Treatment of saphenous vein grafts
- Comparison of:
- DES with other PCI interventions (e.g. atherectomy rotabaltors brachytherapy)
- DES with surgery
- Variations of drug-loading among single DES types ('brands')
Methods for Reviewing Cost-Effectiveness
Inclusion and Exclusion Criteria
Using explicit predetermined criteria two reviewers independently identified reports for inclusion in the review of published economic evaluations and as a source of cost or related data to inform development of the Assessment Group's own economic evaluation and budget impact assessment.
Any disagreements in inclusion for the cost-effectiveness assessment were resolved through discussion.
Inclusion Criteria
Study Design
Full economic evaluations that compared two or more options and considered both costs and consequences including:
- Cost-effectiveness analysis
- Cost-utility analysis
- Cost-benefit analysis
Population
Adults with CAD undergoing treatment of native and intervention naïve vessel(s) by PCI with the use of stent(s).
Intervention
Drug-eluting coronary artery stents which were expected to be available for use by NHS close to the time of the assessment. As for the review of clinical effects.
Comparators
- Drug-eluting stent versus non drug-eluting BMS
- DES of different design
Health Outcomes in an Economic Framework
- Quality adjusted life years (QALY)
- Disease specific measures such as: MACE repeat revascularisations avoided MACE free survival TLR and TVR
Exclusion Criteria
Reports were excluded from the review of economic evaluations if:
- The main source of clinical efficacy data was not explicitly stated
- No attempt to synthesise costs and benefits was conducted
- The source was a letter editorial review commentary or methodological paper.
Number of Source Documents
Clinical Effectiveness
- Seventeen randomised controlled trials (RCTs) (reported in 58 records) comparing drug-eluting stent (DES) with bare-metal stent (BMS) were included.
- Eight RCTs (reported in 11 records) comparing DES with other DES were identified.
- Twenty-seven non-RCTs for assessment of new and existing DES were identified.
Cost-Effectiveness
- A total of 10 full economic evaluations were included
- Seven manufacturers' submissions were provided
Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Meta-Analysis
Review of Published Meta-Analyses
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence
Note from the National Guideline Clearinghouse (NGC): The National Institute for Health and Clinical Excellence (NICE) commissioned an independent academic centre to perform a systematic literature review on the technology considered in this appraisal and prepare an assessment report. The assessment report for this technology appraisal was prepared by the Liverpool Reviews and Implementation Group University of Liverpool (see the "Availability of Companion Documents" field).
Clinical Effectiveness
Data Extraction
Data extraction for the review of clinical effectiveness was carried out by two reviewers. Data were independently abstracted by one reviewer into pretested data extraction forms created within the Access database application Microsoft Corporation and then checked for accuracy by a second reviewer.
Data presented from multiple reports of single trials were extracted onto a single data extraction record.
Quality Assessment
Two of three reviewers independently evaluated the included studies for methodological quality (utilising forms created in Access) using criteria based on Centre for Reviews and Dissemination Report 4 (refer to Appendix 2 of the Assessment Report [see the "Availability of Companion Documents" field]). Any discrepancies in quality grading were resolved through discussion.
Outcomes/Data Analysis
Outcome data from trials comparing drug-eluting stent (DES) with bare-metal stent (BMS) are presented in Table 3 in Appendix 3 of the Assessment Report (see the "Availability of Companion Documents" field). Meta-analysis is presented for mortality acute myocardial infarction (AMI) composite event rate (major adverse coronary and cerebrovascular events [MACE] target vessel failure [TVF]) target lesion revascularisation target vessel revascularisation angiographic binary restenosis rates and late luminal loss.
Data in the form of odds ratio (OR) and 95% confidence intervals (CI) were analysed using the Mantel-Haenszel method fixed-effect model provided by the RevMan Analyses 1.0 application within RevMan 4.2. Similarly for continuous outcomes weighted mean difference (WMD) was analysed.
Heterogeneity was tested by the chi-squared test and the I2 statistic was obtained to describe the proportion of the variability using RevMan Analyses 1.0. Where quantitative heterogeneity was indicated analysis using a random-effects model was conducted for comparison with results of fixed-effect-based analysis.
For convenience studies are grouped according to drug eluted in the meta-analysis. Pooled estimates (OR 95%CI) are provided for each 'eluted drug' subgroup. Pooled effect estimate incorporating available data for all DES analysed are presented in Table 4-3 of the Assessment Report (see the "Availability of Companion Documents" field).
Refer to Section 4 of the Assessment Report (see the "Availability of Companion Documents" field) for more information.
Cost-Effectiveness
Quality of Economic Literature
Ten studies were quality assessed against a standard checklist. In general the quality of data was reasonably high (see Table 6-6 of the Assessment Report [see the "Availability of Companion Documents" field]) except in four key areas. Firstly the resource use was only reported separately from costs in four of the studies making it impossible to validate underlying assumptions. Secondly a discount rate was not applied by one study and no explanation was given as to why not. Furthermore the sensitivity analysis was not fully explained or justified in that study. Finally and most importantly the modelling methodology was poorly described by seven of the studies making it difficult to access the credibility of their models.
Refer to Sections 6 and 7 of the Assessment Report (see the "Availability of Companion Documents" field) for more information.
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
Considerations
Technology appraisal recommendations are based on a review of clinical and economic evidence.
Technology Appraisal Process
The National Institute for Health and Clinical Excellence (NICE) invites 'consultee' and 'commentator' organisations to take part in the appraisal process. Consultee organisations include national groups representing patients and carers the bodies representing health professionals and the manufacturers of the technology under review. Consultees are invited to submit evidence during the appraisal and to comment on the appraisal documents.
Commentator organisations include manufacturers of the products with which the technology is being compared the National Health Service (NHS) Quality Improvement Scotland and research groups working in the area. They can comment on the evidence and other documents but are not asked to submit evidence themselves.
NICE then commissions an independent academic centre to review published evidence on the technology and prepare an 'assessment report'. Consultees and commentators are invited to comment on the report. The assessment report and the comments on it are then drawn together in a document called the evaluation report.
An independent Appraisal Committee then considers the evaluation report. It holds a meeting where it hears direct spoken evidence from nominated clinical experts patients and carers. The Committee uses all the evidence to make its first recommendations in a document called the 'appraisal consultation document' (ACD). NICE sends all the consultees and commentators a copy of this document and posts it on the NICE website. Further comments are invited from everyone taking part.
When the Committee meets again it considers any comments submitted on the ACD; then it prepares its final recommendations in a document called the 'final appraisal determination' (FAD). This is submitted to NICE for approval.
Consultees have a chance to appeal against the final recommendations in the FAD. If there are no appeals the final recommendations become the basis of the guidance that NICE issues.
Who is on the Appraisal Committee?
NICE technology appraisal recommendations are prepared by an independent committee. This includes health professionals working in the NHS and people who are familiar with the issues affecting patients and carers. Although the Appraisal Committee seeks the views of organisations representing health professionals patients carers manufacturers and government its advice is independent of any vested interests.
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
Consideration of the Evidence
After agreeing on the parameters to use in the Assessment Group's model the Committee discussed the resulting incremental cost-effectiveness ratios (ICERs) for the base case and risk groups assuming:
- The absolute risk of revascularization with bare-metal stents (BMSs) for the total population is 11% with resulting risks of revascularization for small vessels of 19% and for long lesions of 11.7%
- The mean number of stents per patient is 1.571
- The relative risk reduction with drug-eluting stents (DESs) for the base case is 55% for the total population and 65% for patients with small vessels and long lesions
- Price differences of DESs over BMSs of 600 and 300 pounds sterling
At a relative risk reduction of 55% with DESs the resulting ICER for the total population of patients was associated with a cost per quality-adjusted life year (QALY) of approximately 171000 pounds sterling at a price difference of 600 pounds sterling and 74000 pounds sterling at a price difference of 300 pounds sterling. For the higher risk groups of patients (that is those with long lesions and those with small vessels) using a DES with a relative risk reduction of 65% the resulting ICERs were associated with costs per QALYs of 126000 pounds sterling and 95000 pounds sterling respectively at a price difference of 600 pounds sterling and 47000 pounds sterling and 25000 pounds sterling respectively at a price difference of 300 pounds sterling.
The Committee agreed that DESs could not be considered a cost-effective use of National Health Service (NHS) resources at a price difference of 600 pounds sterling. After considering the alternative parameter values presented by the Assessment Group and British Cardiovascular Intervention Society (BCIS) the Committee concluded that on balance at a price difference between DESs and BMSs of not more than 300 pounds sterling DESs could be considered a cost effective option in patients with small vessels and long lesions.
Refer to Section 4 of the original guideline document for information on the economic analyses provided by the manufacturers the Assessment Group and the Appraisal Committee considerations.
Method of Guideline Validation
External Peer Review
Description of Method of Guideline Validation
Consultee organizations from the following groups were invited to comment on the draft scope Assessment Report and the Appraisal Consultation Document (ACD) and were provided with the opportunity to appeal against the Final Appraisal Determination.
- Manufacturer/sponsors
- Professional/specialist and patient/carer groups
- Commentator organisations (without the right of appeal)
In addition individuals selected from clinical expert and patient advocate nominations from the professional/specialist and patient/carer groups were also invited to comment on the ACD.
Major Recommendations
Note from the National Institute for Health and Clinical Excellence (NICE) and the National Guidelines Clearinghouse (NGC): This guidance replaces sections 1.2–1.4 of National Institute for Health and Clinical Excellence (NICE) technology appraisal guidance 71 (2003) available from the NICE Web site.
Sections 1.1 and 1.5 of technology appraisal guidance 71 recommend when to use a stent. This part review recommends under what circumstances a drug-eluting stent should be used.
Guidance
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 pounds sterling.
Clinical Algorithm(s)
None provided
Type of Evidence supporting the Recommendations
The type of evidence supporting the recommendations is not specifically stated.
Potential Benefits
Appropriate use of drug-eluting stents for the treatment of coronary artery disease
Potential Harms
There is a risk of stent thrombosis associated with the use of both types of stent (drug-eluting stents [DESs] and bare-metal stents [BMSs]).
For details of side effects and specific contraindications for DESs refer to the instruction for use (IFU) document attached to each DES.
Contraindications
For details of side effects and specific contraindications for drug-eluting stents (DESs) refer to the instruction for use (IFU) document attached to each DES.
Qualifying Statements
- This guidance represents the view of the Institute which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. The guidance does not however override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient in consultation with the patient and/or guardian or carer.
- Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance in their local context in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.
Description of Implementation Strategy
- The Healthcare Commission assesses the performance of National Health Service (NHS) organizations in meeting core and developmental standards set by the Department of Health in "Standards for better health" issued in July 2004. The Secretary of State has directed that the NHS provides funding and resources for medicines and treatments that have been recommended by the National Institute for Health and Clinical Excellence (NICE) technology appraisals normally within 3 months from the date that NICE publishes the guidance. Core standard C5 states that healthcare organisations should ensure they conform to NICE technology appraisals. NICE recognises that many NHS organisations already have contracts in place and therefore would not be able to implement the recommendations contained within the Final Appraisal Determination (FAD) immediately. However as contracts come up for renewal NHS organisations would be expected to use relevant contracting arrangements to ensure that drug-eluting stents (DESs) are obtained in line with the recommendations.
- "Healthcare Standards for Wales" was issued by the Welsh Assembly Government in May 2005 and provides a framework both for self-assessment by healthcare organisations and for external review and investigation by Healthcare Inspectorate Wales. Standard 12a requires healthcare organisations to ensure that patients and service users are provided with effective treatment and care that conforms to NICE technology appraisal guidance. The Assembly Minister for Health and Social Services issued a Direction in October 2003 that requires local health boards and NHS trusts to make funding available to enable the implementation of NICE technology appraisal guidance normally within 3 months.
- NICE has developed tools to help organisations implement this guidance (listed below). These are available on the NICE website (www.nice.org.uk/TA152; see also the "Availability of Companion Documents" field).
- Costing report and costing template to estimate the savings and costs associated with implementation
- Audit support for monitoring local practice
Implementation Tools
Audit Criteria/Indicators
Patient Resources
Quick Reference Guides/Physician Guides
Resources
For information about availability see the "Availability of Companion Documents" and "Patient Resources" fields below.
IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- National Institute for Health and Clinical Excellence (NICE). Drug-eluting stents for the treatment of coronary artery disease. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Jul. 48 p. (Technology appraisal guidance; no. 152).
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
National Institute for Health and Clinical Excellence (NICE)
Guideline Committee
Appraisal Committee
Composition of Group that Authored the Guideline
Committee Members: Professor Keith Abrams Professor of Medical Statistics University of Leicester; Dr Darren Ashcroft Senior Clinical Lecturer School of Pharmacy and Pharmaceutical Sciences University of Manchester; Dr Jeffrey Aronson Reader in Clinical Pharmacology University Department of Clinical Pharmacology Radcliffe Infirmary; Professor David Barnett Professor of Clinical Pharmacology University of Leicester; Dr Peter Barry Consultant in Paediatric Intensive Care Leicester Royal Infirmary; Mr Brian Buckley Lay Member; Professor Stirling Bryan Director Health Economics Facility University of Birmingham; Professor John Cairns Public Health and Policy London School of Hygiene and Tropical Medicine; Professor Mike Campbell Statistician University of Sheffield; Professor David Chadwick Professor of Neurology Walton Centre for Neurology and Neurosurgery; Dr Mark Chakravarty Industry Member; Dr Peter I Clark Consultant Medical Oncologist Clatterbridge Centre for Oncology Merseyside; Dr Mike Davies Consultant Physician University Department of Medicine and Metabolism Manchester Royal Infirmary; Professor Jack Dowie Health Economist London School of Hygiene; Ms Lynn Field Nurse Director Pan Birmingham Cancer Network; Professor Christopher Fowler Professor of Surgical Education and Honorary Consultant Urologist; Mrs Barbara Gerggains Lay Member; Dr Fergus Gleeson Consultant Radiologist The Churchill Hospital Oxford; Ms Sally Gooch Independent Healthcare Consultant; Mr Sanjay Gupta Stroke Services Manager Basildon and Thurrock University Hospitals NHS Trust; Professor Philip Home Professor of Diabetes Medicine University of Newcastle upon Tyne; Dr Peter Jackson Clinical Pharmacologist University of Sheffield; Professor Peter Jones Professor of Statistics and Dean Faculty of Natural Sciences Keele University; Dr Mike Laker Medical Director Newcastle Hospitals NHS Trust; Dr George Levvy Chief Executive Motor Neurone Disease Association Northampton; Ms Rachel Lewis Nurse Advisor to the Department of Health; Mr Terence Lewis Lay Member; Professor Gary McVeigh Professor of Cardiovascular Medicine Queen's University Belfast; Professor Jonathan Michaels Professor of Vascular Surgery University of Sheffield; Dr Neil Milner General Practitioner Sheffield; Dr Ruairidh Milne Senior Lecturer in Health Technology Assessment National Coordinating Centre for Health Technology; Dr John Pounsford Consultant Physician Frenchay Hospital Bristol; Dr Rosalind Ramsay Consultant Psychiatrist Adult Mental Health Services Maudsley Hospital; Dr Stephen Saltissi Consultant Physician The Royal Liverpool University Hospital; Mr Miles Scott Chief Executive Bradford Teaching Hospitals NHS Foundation Trust; Dr Lindsay Smith General Practitioner East Somerset Research Consortium; Mr Roderick Smith Director of Finance Adur Arun and Worthing PCT; Mr Cliff Snelling Lay Member; Dr Ken Stein Senior Lecturer Peninsula Technology Assessment Group (PenTAG) University of Exeter; Professor Andrew Stevens (Chair) Professor of Public Health University of Birmingham
Financial Disclosures/Conflicts of Interest
Committee members are asked to declare any interests in the technology to be appraised. If it is considered there is a conflict of interest the member is excluded from participating further in that appraisal.
Guideline Status
This is the current release of the guideline.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) format from the National Institute for Health and Clinical Excellence (NICE) Web site.
Availability of Companion Documents
The following are available:
- Drug-eluting stents for the treatment of coronary artery disease. Quick reference guide. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Jul. 2 p. (Technology appraisal 152). Available in Portable Document Format (PDF) from the National Institute for Health and Clinical Excellence (NICE) Web site.
- Drug-eluting stents for the treatment of coronary artery disease (part review of NICE technology appraisal guidance 71). Costing template and report. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Jul. Various p. (Technology appraisal 152). Available in Portable Document Format (PDF) from the NICE Web site.
- Drug-eluting stents for the treatment of coronary artery disease (part review of NICE technology appraisal guidance 71). Audit support. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008. 8 p. (Technology appraisal 152). Available in Portable Document Format (PDF) from the NICE Web site.
- Drug-eluting stents: a systematic review & economic evaluation. Assessment report. 2005 Oct 31. 221 p. Available in Portable Document Format (PDF) from the NICE Web site.
Print copies: Available from the National Health Service (NHS) Response Line 0870 1555 455. ref: N1636. 11 Strand London WC2N 5HR.
Patient Resources
The following is available:
- Drug-eluting stents for the treatment of coronary artery disease. Understanding NICE guidance - Information for people who use NHS services. London (UK): National Institute for Health and Clinical Excellence (NICE); 2008 Jul. 4 p. (Technology appraisal 152).
Electronic copies: Available in Portable Document Format (PDF) from the National Institute for Health and Clinical Excellence (NICE) Web site.
Print copies: Available from the NHS Response Line 0870 1555 455. ref: N1637. 11 Strand London WC2N 5HR.
Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.
NGC STATUS
This NGC summary was completed by ECRI Institute on October 17 2008.
The National Institute for Health and Clinical Excellence (NICE) has granted the National Guideline Clearinghouse (NGC) permission to include summaries of their Technology Appraisal guidance with the intention of disseminating and facilitating the implementation of that guidance. NICE has not verified this content to confirm that it accurately reflects the original NICE guidance and therefore no guarantees are given by NICE in this regard. All NICE technology appraisal guidance is prepared in relation to the National Health Service in England and Wales. NICE has not been involved in the development or adaptation of NICE guidance for use in any other country. The full versions of all NICE guidance can be found at www.nice.org.uk.
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