Monday, April 06, 2009


Very often, clinical studies are done so that we can have more data to help medical practice. Lately, we have had some clinical trials where more data seemed to have confused us. I remember September 2006 when the Berne and Rotterdam researchers gave us data that seemed to show that DES are bad. That shook the lay media and clinical interventionist worldwide, alleging that DES was a death trap. Many patients were alarmed and were asking us to explain.
Since then, much more information has come out and have shown to us ( in my opinion conclusively ) that DES are a help and not a harm. Well, at the just concluded ACC 2009 at Orlando, Dr Pamela Douglas, and colleagues from Duke Research Clinic, presented a paper on the use of DES Vs BMS in the elderly population. It was a very impressive study because they studied 260,000 medicare patients, comparing 217,000 patients with DES and 45,000patients with BMS. Their intention was to show that DES was save when compared to BMS, and that DES was better. That they showed. They showed that patients with DES had obviously less AMI and death when compared to BMS, but DES was only slightly better than BMS in terms of repeat -revascularisation. This is where the confusion is. The conventional wisdom is that DES reduced re-stenosis and so should show an obvious reduction in repeat revascularisation. In fact DES may not be much better than BMS in terms of AMI and death reduction. We must try and understand the data from Dr Douglas.
So Dr Douglas and colleagues has given us more data that may increase our confusion. Looks like more data may mean more confusion.
Be that as it may, it is true, from all the data so far, that DES is here to stay. It is a multi-million dollar industry, and that DES is safer than BMS and lessens the need for repeat revascularisation.

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