Stents should be used cautiously

A study has asked heart surgeons to be cautious when deciding whether they should use drug-coated stents on heart-attack patients. The report was presented Tuesday, Sept 4, at the European Society of Cardiology conference in Vienna, Austria.

The study analyzed the records of 2,300 patients from 94 hospitals in 14 countries known as the Grace registry. The study said there were indications that death rates among patients fitted with drug-coated stents were higher than those with bare-metal stents, and this apparently were related to patients who had been treated for heart attacks. It showed that death risks increased for patients with drug-coated stents after the first six months.

The study concluded that drug-coated stents should be used cautiously in patients being treated for heart attack. But the study author said that this warning was most applicable in patients who were given stents following STEMI (It is known that there is a small risk of blood clots developing after the first year when using drug-eluting stents. This condition is known as “late stent thrombosis”. The risk is less than 1 percent of patients, but of those affected nearly half are likely to die. ), which is the most deadly type of heart attack.

This probably reflected the higher risk of thrombosis in STEMI patients. The study author said he still believed there are many patients who will benefit from the use of drug-coated stents, but STEMI patients are not among them.

Stents are tiny tubes of metal mesh which are inserted in blood vessels to prop them up and keep them open after surgery. Two kinds are used in surgery: bare-metal and drug-coated stents. The drug-coated stents, also called drug-eluting stents (DES), release drugs straight into blood vessels to prevent them from becoming narrow again. This lowers the chances that surgery may have to be repeated, as happens with the bare-metal stents.

Drug-eluting stents gained popularity in the last five years and was used in more than six million patients all over the world, especially in the United States. Since last year, however, their safety was questioned and use decreased significantly.

It is known that there is a small risk of blood clots developing after the first year when using drug-eluting stents. This condition is known as “late stent thrombosis”. The risk is less than 1 percent of patients, but of those affected nearly half are likely to die.

A spokesman for the European Society of Cardiology noted that the study tells doctors not to be indiscriminate when they consider using drug-eluting stents. Drug stents have stirred controversy among cardiologists, partly because of fears about late stent thrombosis.

Makers of drug-eluting stents have reacted to the study, saying it is inconsistent with the findings of other studies. A Swedish study also presented at the conference found no overall increased risk after four years of follow-up. It will be some time before the controversy is put to rest.