Cardiologists Say Stent Questions Remain
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LEXINGTON, Ky. (Jan. 29, 2008) − A larger, longer-term registry of people
treated with drug-coated stents may be needed to help heart specialists and their patients make
decisions about treatment options for blocked heart vessels, two University of Kentucky
cardiologists say in the current issue of the Journal of the American Medical
Association.
An editorial by Dr. David Moliterno and Dr. Debabrata Mukherjee accompanies study results of SORT OUT II, the largest direct comparison of two kinds of stents used to prop open blood vessels like scaffolding a collapsed tube. Moliterno is director of the UK Linda and Jack Gill Heart Institute, and Mukherjee is director of the cardiac catheterization laboratories at UK. Both are interventional cardiologists and faculty members of the UK College of Medicine.
The study examined the outcomes of patients who received drug-eluting stents, which are coated with medicine to help prevent scar tissue from forming over the site of the stent and causing further blockage, increasing the risk of heart attack or angina. Without stents, about 40 percent of patients treated for blockage have a need for a second procedure at the same site, compared to about 20 percent with regular stents and only about 7-8 percent of patients who receive drug-coated stents. Although the study found no significant differences in outcomes among patients receiving two different kinds of drug-coated stents, Moliterno and Mukherjee say that the study may raise more questions than answers.
They note that less than a third of the patients in the study were chosen at random, and that while the study is the largest of its kind to date, a larger study is needed to more closely examine how the types of stents compare. SORT OUT II consisted of less than 3,000 men and women studied at five university hospitals in Denmark. In the study, 2.5 percent of patients in one group and 2.9 percent in the other group suffered stent thrombosis, a rare but risky complication that occurs when a blood clot forms at the site of the stent. Those results seem higher than expected and reinforce the need for meaningful patient-physician discussion about long-term anti-clotting therapy when a stent is used, Moliterno and Mukherjee note.
"A large longitudinal database for patients receiving these various drug-eluting stents with open entry to fully capture all procedures may help determine the safest and most effective revascularization practice possible and should help guide future recommendations," they wrote.
An editorial by Dr. David Moliterno and Dr. Debabrata Mukherjee accompanies study results of SORT OUT II, the largest direct comparison of two kinds of stents used to prop open blood vessels like scaffolding a collapsed tube. Moliterno is director of the UK Linda and Jack Gill Heart Institute, and Mukherjee is director of the cardiac catheterization laboratories at UK. Both are interventional cardiologists and faculty members of the UK College of Medicine.
The study examined the outcomes of patients who received drug-eluting stents, which are coated with medicine to help prevent scar tissue from forming over the site of the stent and causing further blockage, increasing the risk of heart attack or angina. Without stents, about 40 percent of patients treated for blockage have a need for a second procedure at the same site, compared to about 20 percent with regular stents and only about 7-8 percent of patients who receive drug-coated stents. Although the study found no significant differences in outcomes among patients receiving two different kinds of drug-coated stents, Moliterno and Mukherjee say that the study may raise more questions than answers.
They note that less than a third of the patients in the study were chosen at random, and that while the study is the largest of its kind to date, a larger study is needed to more closely examine how the types of stents compare. SORT OUT II consisted of less than 3,000 men and women studied at five university hospitals in Denmark. In the study, 2.5 percent of patients in one group and 2.9 percent in the other group suffered stent thrombosis, a rare but risky complication that occurs when a blood clot forms at the site of the stent. Those results seem higher than expected and reinforce the need for meaningful patient-physician discussion about long-term anti-clotting therapy when a stent is used, Moliterno and Mukherjee note.
"A large longitudinal database for patients receiving these various drug-eluting stents with open entry to fully capture all procedures may help determine the safest and most effective revascularization practice possible and should help guide future recommendations," they wrote.