Cardiologists have proposed a ‘stent scoring system’ to help heart patients and their families chose quality stents at the right price.
Stents are used during angioplasty, a procedure carried out to correct the narrowing of blood vessels.
Doctors said the scoring system will help the government determine the right price for stents. Currently, the prices are decided by the manufacturer without any regulation.
While patients may think that costlier stents are of better quality and give better clinical results, this may not always be true. Hence, the need for an objective scoring system, said doctors. Depending on the cost of the stent, the cost of an angioplasty can vary widely, giving patients little control on the cost.
Prices can range from Rs25,000 to Rs1,00,000, depending on the brand.
“At a time when the market has a wide array of stents, a scoring system will help patients make comparisons,” said Dr Sundeep Mishra, professor of cardiology at All India Institute of Medical Science (AIIMS), Delhi, who has proposed the scoring system in the latest edition of the Indian Heart Journal (IHJ).
The system, said doctors, aims at scoring stents between 0 and 20, depending on the stent’s technological advancement along with the numbers of long-term clinical studies on the efficacy and side-effects. The score will rank stents based on the nature of the material used in the stent, thickness, design and data on the numbers of its long-term studies, said Dr Mishra. “There are stents which have the most advanced technology, but there aren’t many long-term clinical studies available on them.”
For example, bio-absorbable stents, which dissolve in the body over a period of time, rank high on the quality of material compared to first generation stents that were made of stainless steel, but rank low on the number of long-term follow up studies available, he said.
“The scoring system in a novel idea to classify the stents on how good they are in terms of influencing the restenosis rate,” said Dr Anil Kumar, professor of cardiology, Sir JJ Hospital, Byculla. Restenosis is reoccurrence of the narrowing of a blood vessel, leading to restricted blood flow. “It will help the doctors to understand a stent, after taking into account all the factors described in the scoring system.”
However, Dr Ashwin Balachand Mehta, cardiologist, Jaslok Hospital, said such a scoring system is far from complete. “In a scoring system like this, there are so many variables. How does one decide which one is the gold standard to make the comparison?”
How will the stents be rated
The system, said doctors, aims at scoring stents between 0 and 20, depending on the stent’s technological advancement along with the numbers of long-term clinical studies on the efficacy and side-effects.
For example, bio-absorbable stents rank high on the quality of material compared to first generation stents that are made of stainless steel, but rank low on the number of long-term follow up studies available.