Monday, June 30, 2008


Last month, I commented that the Journal of the American College of Cardiology, published a study of Medicare data, which showed that DES is safe ( as safe as bare metal stents ) and is obviously good for the patients as they reduce the risk of repeat revascularisation. This current issue of the Journal of the American Medical Association, also carried an article by the Dartmoor Medical Center, reviewing insurance data over two years, which again showed basically the same. There was however a difference in that the first study did show that the use DES also reduce the risk of death, and AMI. This was not seen in the second article. It looks like, we can all take heart that the use of DES is not associated with a higher incidence of late stent thrombosis. Not any higher then bare metal stents. Looks like the Europeans in September 2006, at Barcelona, did us all a great injustice. With that behind us, maybe the Interventional Cardiology community can move on ahead and concentrate on producing better DES that will require us to take dual anti-platelet agents for a shorted duration. I find that to be costly and a nuisance. If DES are better, we can also safely, stop their plavix should they require unscheduled elective non-cardiac surgery, as we do with bare metal stents. As I have been discussing in Interventional forums across Asia, the second generation DES are very good, in terms of procedural success rates and safety. They are also very effective in reducing re-stenosis. The need for prolonged dual anti-platelet agents ( US guidelines are for as long as 1 year ), can be a drain on the finances and also a nuisance in many ways. Over in Bangkok last week, I failed to notice any big advances in the DES field. They is a lot of marketing, and it does look like the cost of DES will come down in the near future. We will soon seen the entry of Chinese made DES in the Malaysian market, at almost half the price of the US ones. I must say that my review of the Chinese DES ( example, the excel DES ), is safe and good. The prime movers of the first generation of DES is suffering from the their Asian rivals, both in Asia and I believe soon also in Europe and Japan. But I have always maintained that lowering cost without lowering safety and efficacy, is good for the patients, the ultimate consumer.

No comments: