Indications for the use of coronary stents are evolving and their optimal place in therapy remains to be defined. OBJECTIVE: The purpose of this analysis was to compare the one-year clinical and economic outcomes of percutaneous transluminal coronary angioplasty (PTCA) with or without the use of stents. METHODS: This retrospective database analysis, from 60 U.S. academic medical centers in 1996 and 1997, included 27,020 patients that either did (n=13,254) or did not (n=13,766) receive stents in conjunction with PTCA. Outcomes of interest included in-hospital mortality (both on sentinel and readmission visits), readmission rates, revascularization procedures, length of stay, and the cost of sentinel and readmission hospitalizations. RESULTS: The median hospitalization cost for the stent group was about $1,409 higher than for the no-stent group, even though they had similar lengths of stay (4.3 days vs. 4.5 days respectively, p = 0.001). While mortality rates on readmissions (0.9% stent vs. 0.8% no-stent, p = NS) did not differ, stent placement during the sentinel event was associated with improved survival (1.7% vs. 2.7%, p <0.001). In multivariate analysis, stent use was not associated with a significantly lower risk of a revascularization procedure on readmission to the same institution [OR 0.95, 95% CI (0.87 1.04), p = .28]. From the health-care system s perspective, 106 patients would need to be treated with a stent to prevent one death on sentinel admission. CONCLUSION: Stent use decreased in-patient mortality by 1% without impacting length of stay or readmission rates. At $149,354 per life year saved, stents would need to increase a person s life expectancy by a minimum of three years over that which is gained from PTCA alone to remain a cost-effective alternative.