More patients with drug-coated cardiac stents survive, avoid costly follow-up procedures

The more than ten million Americans who’ve received drug-eluting stents to open their blocked coronary arteries have a bright future, according to new research from the University of Pennsylvania School of Medicine.

The findings, among the first large follow-up studies to show a clear, lifesaving benefit of drug-eluting stents compared to bare metal stents, will be published in the May 27 issue of the Journal of the American College of Cardiology. Patients with the drug-coated stents -- designed not only to open blocked coronary arteries but also to chemically inhibit future blockage -- were less apt to die, have heart attacks or require extra stents or bypass surgery in the two years following placement of the stent.

“This might be a hidden nugget of goodness that could not be detected in clinical trials,” says Peter W. Groeneveld, MD, MS, assistant professor in Penn’s Division of General Internal Medicine. “There is a distinct possibility that drug-eluting stents not only reduce the need for future cardiac procedures, but also save lives.”

Groeneveld and his colleagues studied Medicare data to identify about 72,000 patients who received drug-eluting stents during a nine-month period in 2003, the first year the devices were approved for use in the United States. Overall, the findings showed a clear survival benefit compared to a control group of patients who got bare metal stents -- at 90 days, 1 year and 2 years, patients with drug-coated stents were less likely to die.

In a separate study which will be published in the June issue of the American Heart Journal, Groeneveld also found that drug-eluting stents also offer cost savings during the first year after placement. Although the initial cost of the device – averaging $16,000 -- outpaces that of a bare metal stent, which costs about $14,000, the Penn researchers found that among patients with the drug-coated stents, 12 percent of those studied needed additional stents placed in the first year, compared to 15 percent of patients who received bare-metal stents.

Few patients in either arm required bypass surgery in the first year following stent placement, but those who received bare-metal stents were twice as likely to need the procedure, leading to an additional cost savings of $714 per patient treated with drug-coated stents. Overall, researchers found that patients with drug-eluting stents each saved an average of $1,350 worth of follow-up care during the year, which projects a total savings of approximately $100 million dollars among the 72,000 drug-eluting stent patients studied.

The researchers note that future studies should focus on how drug therapies including clopidogrel and cholesterol-reducing statin drugs may play a role in outcomes and costs for both types of stent patients. Since recent evidence shows that clopidogrel therapy -- aimed at reducing the risk of blood clots following stent placement -- is an essential step for reducing “late” drug-eluting stent complications or failure, Groeneveld theorizes that clinical outcomes for drug-eluting stent patients might be boosted even further when patients follow an appropriate long-term drug regimen.

Source: University of Pennsylvania

Related stories:

Best use of drug-eluting stents
Compared with bare metal stents, drug-eluting stents substantially reduce the risk of angiographic and clinical recurrence but do not affect mortality or the short term or long term risk of myocardial infarction. The use of drug-eluting stents necessitates extended treatment with dual antiplatelet therapy (aspirin plus thienopyridine) which may cause bleeding complications and interferes with or even precludes surgery in case this is needed.
Study: Bypass better than stents in long term
(AP) -- For heart patients with clogged arteries, the choice between bypass surgery or an angioplasty may come down to one question: How many procedures would you like to have? In research presented Monday at the European Society of Cardiology meeting in Munich, experts concluded that while bypass surgery and angioplasty offer comparable results, patients who have angioplasties are twice as likely to require another procedure within a year.
Tiny 3-D ultrasound probe guides catheter procedures
An ultrasound probe small enough to ride along at the tip of a catheter can provide physicians with clearer real-time images of soft tissue without the risks associated with conventional x-ray catheter guidance.
Risk of repeat attacks in heart patients causes concern for doctors
An international study, led by the University of Edinburgh, raises concerns that some patients may not be receiving the optimum medical treatment and follow-up care because doctors are misjudging the risk of a further heart attack.
More aortic chest aneurysms being treated with less-invasive stents
An estimated 60,000 Americans are walking around with time bombs in their chests called thoracic aortic aneurysms. At any time, their main chest artery could suddenly burst open, causing massive internal bleeding that is almost always fatal.
Stent grafts: a better way to treat blunt trauma injuries
Endovascular repair—fixing an injury in a blood vessel from inside that vessel—is a better option for individuals who receive highly lethal injuries from high-speed collisions or falls (together referred to as blunt trauma) and is shown to save more lives and nearly eliminate paraplegia (the loss of the ability to move and/or feel both legs), a complication of surgical repair for thoracic aortic aneurysms.
Just dive in: Natural product hybrid provides antimicrobial and cell-resistant surfaces
(PhysOrg.com) -- Infections following treatment in clinics, retirement homes, and long-term care facilities are a grave problem for patients, and resistant germs can be particularly devastating.
Still puzzling: Best care for the frail and elderly with coronary artery disease
A new study from Duke University Medical Center finds that patients treated solely with medications after suffering from chest pain, heart attack or coronary artery disease are more likely to die during the first year following their initial hospitalization.

News discussion:

Medicine & Health news