Researchers Drill Down for DES Safety, Efficacy
One of the problems with drug-eluting stents (DES) is their risk of stent thrombosis. A new analysis of HORIZONS-AMI data found that stent thrombosis is directly linked to particular drug therapies. At its essence, drug therapy for PCI patients should include a loading dose of 600 mg of clopidogrel and a heparin bolus in the emergency department to reduce stent thrombosis.
A criticism often bandied about after data from large-scale trials are released is that the results won’t translate into “real-world” practice. A large study from Duke University used an ACC database and information from Medicare to extrapolate the safety and efficacy profile of DES. Across all categories, DES were found to be comparable if not superior to bare-metal stents (BMS). Researchers touted the study as proving that DES can be safely used in real-world practice.
Recently, the SYNTAX trial made headlines because it laid out in clear terms the types of patients who benefit most from PCI versus CABG. At the ACC meeting, SYNTAX researchers went further and found that PCI was cost-effective in low- and intermediate-risk patients. Interventional cardiologists are now praising the two-pronged approach of SYNTAX results.
Moving from DES to perhaps the fourth-generation stents, researchers found that the Genous, which is bioengineered to reduce stent thrombosis, did not fare well compared to a third-generation BMS. They say they need more data before drawing conclusions. Abbott, however, turned in good results for its bioabsorbable stent after two years’ follow-up and is initiating the next phase of study.
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C.P. Kaiser, Editor