TCT: Stent reps in cath lab influence stent selectionshould they be kicked out?

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SAN FRANSISCO—When stent manufacturers send their representatives to the cath lab, their presence can influence the interventionalist’s choice of stent, according to a study presented at the 21st annual Transcatheter Cardiovascular Therapeutics (TCT) conference.

HoHai Van, MD, from the division of cardiology at Stanford University in Stanford, Calif., told Cardiovascular Business News that the stent representatives serve various roles in the cath lab, such as education purposes and product support. “They will often visit to explain the specific usages and unique characteristics of their product, including its dilations components,” he said.

However, he and his colleagues have become increasingly concerned that representatives from stent manufacturers may influence stent selection by their presence in the cath lab.

Also, the authors noted that there have been few attempts to study or quantify the data on their impact.

The researchers retrospectively reviewed stent implantation patterns at Stanford for six months from October 2008 to April. Visits from the stent representatives were independent and self-scheduled. They were allowed in the lab and interacted with the operators. The investigators analyzed the effect of the representative’s presence on implantation of their stent using the Chi-square test. For anonymity purposes, the authors identified the manufacturers as A, B, C and D.

During the study period, a total of 431 stents were implanted. Of those procedures, they found that 36 percent were from A; 53 percent from B; 6 percent from C; and 5 percent from D.

Compared to stent usage without any industry representatives, the presence of one increased the use of stents of each manufacturer: from 40 percent to 52 percent for A; from 52 percent to 86 percent for B; from 5 percent to 22 percent for C; and from 3 percent to 40 percent for D.

“The two companies with the lowest overall market share had approximately half of the total stent implants during the study period on the days of representative’s visit,” the authors wrote.

Van noted that the only influence that he and his colleagues observed was stent selection.

Based on their findings, the authors concluded that the presence of stent manufacturer representatives significantly increases stent utilization from their respective companies. Van said that he and his colleagues think more research needs to be done.

“Our plan is to eliminate the potential corporate bias that could potentially influence the choice of the stents by not having reps present in the cath lab during procedures,” Van explained.