Thursday, May 17, 2007

DES; More Lessons Learnt

In 2001, DES was hailed as the revolution in Interventional Cardiology. Now 6 years later, it is viewed with suspicion by the lay public and caution by the interventional fraternity, ever since the infamous presentations by the Berne-Rotterdam axis at the September 2006 meeting of the European Society of Cardiology. Many in Interventional Cardiology, bombarded by skeptics (no shortage of them) who prophesied the last days of DES, feel that perhaps the using bare-metal stents (BMS) is not such a bad idea after all. They have very quickly forgotten the days when every 3rd to 4th patients after BMS, will return for re-vascularisation. Perhaps the blessing in disguise for us, balloonatics, is that we have become more circumspect about using DES. We exercise greater caution is choosing the right patients for the DES (not just affordability alone).

The JAMA vol 297, year 2007, carried two DES registry reports which to me merit watching. I suppose the authors of the paper were trying to answer the question, does "off-label use " of DES contribute to the greater MACE events. Most of us will reflexly say yes. Using the DES in situations where they were not proven to be effective and safe, must run the risk of more failures and adverse events. The message for us "balloonatics " is that when you use a DES "off-label" be prepared to accept more late stent thrombosis, uncertainty in the duration of Plavix, and possible more re-stenosis and other adverse events. Put another way, use DES "on-label " to avoid undue problems. Maybe many are doing that, for the market news is that the usage of DES has dropped and the usage of BMS has increase. I do hope that all this will translate to better patient care.

1 comment:

Steven said...

Steven said...
DES good?.. hardly... not if you are the one who is suffering from ACS literally every day for 5.5years as a result of a DES... I am finding that Celebrex is a bit helpful (suggested by head of a cath lab at different hospital than the one mine was placed in) ... and looking for natural methods, top fish oil, herbs etc., anyting to stop this daily severe and dangerous vascular inflammation and pain. It has been a 10 of pain almost every day since the day after I had a large Cypher DES placed in my Osteum of LAD. Also thousands are all over the web complaning about significant post stent chest pain/angina with completely patent DES stents... really getting quite common. Every middle aged man I have met with a DES has the problem like mine. Older people don't complain, because the doctors tell them "it your heart", you are old and sick, or "not right in the head". There are also dozens of articles and studies on post stent pain, inflammation, allergy, especially for the DES... yet interventionists are still in (monetary) denial... Surgeons however are now speaking up for the first time about stents (especially DES) heated arguments are going on in hospitals. The DES is junk, dangerous... careful ballooning, followed by rest and the many available medicines and strict change in diet, untimately later excercise, all far preferable... and if need be, a bare metal in the most dire of proven cases. Otherwise forget the DES, until they invent something that does not first "harm" the patient... I am suffering every day, and have tried everything to no avail... some courageous interventionists are suggesting Celebrex, with increasing aspirin; next choice Prednisone (a dangerous choice, but what else to do) by some interventionists. Some articles and studies on the various "treatments" are on the web. But most interventionists are just blowing off the patients. Some other interventionists however are also suggesting antihistamines, and various immune altering drugs, but this is dangerous. Antihistamines did not help me at all... good idea though... only Celebrex helps me, and only a little bit, at 400mg per day. I am left to experiment on myself as many thousands of others are, suffering from "stent-osis"... far worse than arteriosclerosis, as there in apparently nothing you can do to cure stent-osis, not vigorous exercise, nothing, and the vessel just gets more inflammed the more you exercise or do anything. Bypass and removal of stent becomes all the more dangerous with stents in the way, having been inflammed in the vessel, etc. My advise: never, ever, ever allow any doctor to put a DES in you heart, ever...

10:13 PM