The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Bioresorbable stent implantation for treating coronary artery disease in May 2014.
Coronary artery disease is narrowing (stenosis) of the coronary arteries caused by deposition of atherosclerotic plaque. This reduces blood flow to the heart muscle and is usually progressive. Symptoms of coronary artery disease typically include angina – chest pain that is exacerbated by exertion. A critical reduction of the blood supply to the heart may result in myocardial infarction or death.
The symptoms and health risks associated with a stenosed artery may be treated medically, by modifying risk factors (for example, smoking, hyperlipidaemia, obesity and hyperglycaemia) and by drug treatment (for example, beta-adrenergic blockers, nitrates, calcium-channel blockers, antiplatelet agents and statins).
If medical management fails or is inappropriate, the usual options are surgical coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (usually with insertion of a bare metal or drug-eluting stent). Stents are inserted with a view to maintaining the patency of coronary arteries after balloon dilatation.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not 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.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.