Drug-Eluting Stents Prove Mettle in Heart Attack Patients
Interventional Cardiologists and Patients Can Be Confident in New Treatment Choice
BETHESDA, MD -- July 13, 2005 -- Drug-eluting stents are a safe and effective treatment for heart attack, provoking no increase in complications when compared to conventional stents and cutting the risk of arterial renarrowing by 90 percent. These are the findings of a new study published in the August 2005 issue of Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions.
The study fills an important information gap in the treatment of high-risk patients. Until now, patients with heart attack, or myocardial infarction, have been excluded from studies of drug-eluting stents. Physicians often use drugs and devices that have been approved in one group of patients to extend treatment to a new group of patients, however.
“There is increasing use of drug-eluting stents as the primary treatment for acute myocardial infarction. We wanted to know whether it was safe,” said Ron Waksman, M.D., associate director of cardiology at Washington Hospital Center in Washington, D.C.
Drug-eluting stents are expandable metal tubes that prop open an artery supplying blood to the heart while slowly releasing a drug that over time prevents renarrowing, or restenosis. Drug-eluting stents were originally proved safe and effective in patients with simple arterial narrowings causing chest pain, not in patients with heart attack.
The new study involved 103 heart attack patients who were treated with the Cypher stent (Cordis Corp.). This stent is coated with sirolimus, a medication that prevents the overgrowth of scar tissue from the arterial wall into the center of the stent. Patients treated with the Cypher stent were compared to 504 heart attack patients who had been treated with a bare metal stent in the preceding five years.
Dr. Waksman and his colleagues found that treating heart attack patients with the drug-eluting stent was safe. There was no difference between the two groups in procedural complications. Another key finding: No patient developed a blood clot in the drug-eluting stent within a month of treatment, a serious complication known as subacute thrombosis. This is especially reassuring, given that heart attacks are themselves often caused by a blood clot, or thrombus, that blocks the artery following rupture of an inflamed plaque.
“When you have a group of patients who already have a thrombotic milieu, you want to make sure that you’re not risking further thrombosis with the use of drug-eluting stents,” Dr. Waksman said.
The study also showed that drug-eluting stents accomplished their primary purpose, preventing the need for a repeat procedure to treat renarrowing in the stented artery. At six-month follow-up, only 1 percent of patients treated with the drug-eluting stent required a new procedure to reopen the artery, as compared to more than 10 percent of patients treated with the bare metal stents.
“Our study reassures interventional cardiologists and patients that we have no reason to worry about using these stents in treating acute myocardial infarction. They appear to be safe—that’s the most important thing—and also effective,” Dr. Waksman said.
Dr. Waksman and his colleagues are considering conducting a head-to-head comparison of two types of drug-eluting stents in the treatment of heart attack: the Cypher stent and its competitor, the Taxus stent (Boston Scientific), which is coated with a different anti-renarrowing drug, paclitaxel.
Headquartered in Bethesda, Md., the Society for Cardiovascular Angiography and Interventions is a 3,400-member professional organization representing invasive and interventional cardiologists. SCAI’s mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI was organized in 1976 under the guidance of Drs. F. Mason Sones and Melvin P. Judkins. The first SCAI Annual Scientific Sessions were held in Chicago in 1978.
The Society for Cardiovascular Angiography and Interventions provides news reports of clinical studies published in Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions (CCI) as a service to physicians, the media, the public, and other interested parties. However, statements or opinions expressed in these reports reflect the view of the author(s) and do not represent official policy of SCAI unless so stated.
Source: Society for Cardiovascular Angiography and Interventions
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