Review of NICE Technology Appraisal Guidance No.71: Guidance on the use of coronary artery stents

Proposal to update the guidance within a Clinical Guideline

As you may be aware the planned date for review of the above guidance was April 2014; this review only covers recommendation 1.1 and 1.5. Recommendations 1.2, 1.3 and 1.4 of TA71 were updated and replaced by TA152; Drug-eluting stents for the treatment of coronary artery disease.

The review date is the date at which the Institute decides whether sufficient new evidence has emerged for the Appraisal Committee to be asked to undertake a full appraisal review.

The Institute has concluded that because bare metal stents have been considered standard of care for several years, it is not considered useful to carry out an update of the still extant recommendations 1.1 and 1.5 of TA71 as a technology appraisal. However, it would be beneficial for these recommendations to be updated when CG167 (Myocardial infarction with ST-segment elevation) and CG94 (Unstable angina and NSTEMI) are reviewed in July 2015 and September 2015 respectively. It has previously been agreed to update the TA152 (drug eluting stents) in these clinical guidelines.

This would lead to all NICE's recommendations on the use of stents to be brought together within the entire context of clinical management of the conditions, which will allow for an analysis of the new technologies and ongoing research which compares drug-eluting stents and bare-metal stents. The clinical guidelines can also contextualise the use of stents with the use of CABG.

As a result, we believe that TA71 should be updated and replaced by CG167 (Myocardial infarction with ST-segment elevation) and CG94 (Unstable angina and NSTEMI). Following publication of the guidelines, the remaining recommendations 1.1 and 1.5 within TA71 will be withdrawn.

In order to be completely confident that this is appropriate, we are asking all relevant consultees and commentators, to inform us of any evidence which will help us decide the best way to update this guidance. Please see appendix A for a full list of the organisations we have contacted.

July 2014

Attachments