Monday, May 11, 2009


The interventional cardiology community is really working hard to fight of the ghost of Sept 2006, Barcelona, where they were bashed by reports that DES were killing more than they were helping. Since then , we have seen publications after publications, presentations after presentations at international meetings that DES is safe and much better then bare metal stents.
Well, last week is no exception. It saw the publication of the SCAAR and Horizon-MI re-analysis of their earlier presented data, and this week in J of the American College of Cardiology of the Ontario registry. All showing that DES were better than bare metal stents in a variety of clinical conditions including primary angioplasty for AMI, SVGs, Left Main Stems, etc, etc. DES have proven to be safer and with better longterm outcomes including less target lesion re-vascularisation. It is fair to say that some of the data analysed, were with two year follow-ups and some with 6 years follow-up ( the SCAAR began in 2003 ).
Even on our shores, I hear less enquiries about " Is the medicated stents safe ?" as opposed to three years ago. Our patients have accepted the DES and we still continue to implant a fair amount of DES every week and month. So far so good. Except of course the cost.
Last week, I saw a family who came to enquire on behalf on a ill relative. He had severe triple vessel disease with poor LV, and is now in heart failure with chest pains. The angiogram report seem to support the need for revascularisation. I discussed that he could go for CABG, which would cost about RM 30-40K nowadays, or PCI with 4 DES which would cost about RM 40-50K. So that with DES for 3VD-CAD, the cost of PCI is the same or even a bit more than CABG. The choice may have to be, which is better in terms of short-term risk and long term outcome.
Basically, what I am saying is that DES is here to stay and we will soon see better and better DES. The problem is, cost may go up.

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