Arkansas has the lowest coronary drug-eluting stent (DES) penetration rate in the U.S. at 49 percent, followed closely by Montana, Utah and South Dakota, according to a report from medical market research firm Millennium Research Group (MRG).

According to the authors, these numbers contrast the national picture, in which DES represent an overwhelming 70 percent of coronary stent procedure volumes and, due to their higher price point premium, 84 percent of coronary stent revenues.

The penetration of DES at the hospital level depends heavily on hospital profile, according to MRG's analytics tool, Procedure Finder: Interventional Cardiology.

Urban hospitals, which are more likely to have elevated bed counts, budgets and patient volumes, are more likely to use premium-priced DES in their coronary stenting procedures, the researchers found. In contrast, rural hospitals with smaller bed counts, tighter budgets, and lower patient volumes are more likely to use bare-metal stents (BMS), if they perform coronary stenting procedures at all.

“Nowhere is this more evident than in Arkansas, where BMS are used in an overwhelming 64 percent of cases performed in rural hospitals (compared with 35 percent nationally),” the authors wrote.

"There are only five rural facilities performing coronary stenting procedures in Arkansas and the busiest of those—White River Medical Center in Batesville—uses BMS almost exclusively," said Aaron Dickson, co-president of MRG. "Similarly, the state's largest stenting facility—the Arkansas Heart Hospital in Little Rock—performs nearly 4,000 stenting procedures annually and is using DES in less than 20 percent of them."

The report concluded that the relatively low urbanization of the state is likely affecting even those facilities located in urban areas, leading to low overall DES penetration in the state compared to more densely populated regions.