Wednesday, January 24, 2007

More Confusion - Late Stent Thrombosis with DES

At the recently concluded SingLive 2007, (SingLive is the regions longest surviving Interventional Cardiologies live demonstration course, for the last 16 years), the Japansese workers presented findings from their 15,000 Cypher DES stent registry (the J-Cypher registry).

Of the 15,000 cyphers, about 5,000 cyphers have 1 year followup. A few points were worth noting. In Japan, plavix is not approved, so all their patients with Cypher received ticlopidine for 1 year following cypher implantation. Their registry had a higher proportion of patients above 80yrs, more diabetics and more renal failure when compared with e-cypher (the European Cypher registry).

Despite these differences, the J-cypher registry had lower incidence (almost half the rates) of late stent thrombosis (LST) till 1 year. This certainly is interesting, if you consider, that the J-Cypher registry had a "more LST-prone" population.

A possible key difference is that the Japanese patients like western medicine pills (the more the better). They have much faith in western medicine. Their medication are all paid by their health insurance and their compliance rate with medications is high. Could these be the reason why they have a lower LST, or is there something in the diet? Well the good news is that Malaysians may be closer to Japanese then Europeans, if you know what I mean.

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