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.
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.
