Friday, September 02, 2011


Well, the European Society of Cardiology, Annual Scientific meeting 2011 has concluded in Paris. I had the look at what was presented, and my take is that nothing earth shuttering was revealed. Our last post was on the newer CETP inhibitors, and we need to keep a close watch on this knowing that it could be of great benefit to our patients and knowing also that we have failed once with Torcetrapid.
On the interventional end, I see that second generation DES role is firmly established and there is almost deafening silence on the ABSORB bio-degradeable DES stent.
1. On the 30th August, there were 32 papers on the Xience V ( everolimus eluting DES by Abbott ). My friend from Japan, Dr Kimura presented the findings of the RESET study. A 3,200 patient study, comparing the use of the Xience V DES ( just approved in Japan 1 year ago ) with the Cypher sirolimus eluting ( now removed from the market place ) by JnJ Cordis. Basically, the results showed that Xience V was as good as Cypher ( not surprising ). We have seen the same conclusion with ISAR Test 4 and SORT OUT 4. No surprises.
2. Paris also saw the presentation of longer term data from the SCARR registry ( this guy gave us a scare in 2006 remember ) and the Bern Rotterdam data ( this guy also gave us a scare in 2006 ), showing that out to 4 years, the Xience V DES is safer, have less late stent thrombosis ( almost non ) and also less TLR.

These two papers basically confirmed what we know. That second generation DES are safer and better, especially in the longer term. Looks like stent design, drug dosages, elution characteristics and refined polymer coatings have made a difference. We have learn our lessons well.
In fact, the second generation DES are so safe now, that we can advocate their use in AMI ( a high thrombus load millieu ). This was also highlighted in a paper by Dr Sabate ( Barcelona ), on the use of Xience V in acute STEMI. The EXAMINATION study. There was no difference in the primary end point, when comparing Xience V with Abbotts multilink bare metal stent. No difference in the stent thrombosis rates. There was significant difference in the secondary end points of TLR, and TVR. Of course the caveat here is that the dual anti-platelet compliance rate was 95%. That is important to note. basically, do not use a DES in Acute STEMI, if the patient cannot comply with DAPT.
Looks like there was alot of Xience V in Paris, and Paris also see the withdrawal of Cypher ( so sad ).
Looks like Interventional Cardiology has reached a plateau.

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