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October 3, 2006 -- 9:18pm ET

"Elective" Procedures: Current Voting Trends
Before an election, there are usually polls, and recently there have been several done of the interventional cardiology community that are telling. Various device companies have said for some time now that studies have shown no real difference in late stent thrombosis rates between drug-eluting stents and bare metal stents.

They've also stated that they have not seen any indication in their sales figures of a significant switchover back to the bare metal variety. But stent sales figures for this past quarter and the results of three polls paint a different picture.

First off, an AP story today, subtitled "Analyst Rethinks Ratings Given Heightened Blood Clot Concerns on Drug-Coated Stents", reports that Merrill Lynch posed questions about drug-coated stent safety to 50 "heart surgeons" (we believe the AP writer meant "interventional cardiologists" -- cardiac surgeons would rather not think about stents at all, a device which has eroded bypass surgery to less than 1/3 of all procedures). The responses were as follows:

Will slightly reduce use of DES
32%
Will greatly reduce use of DES
8%
Will completely stop use of DES
2%
Not sure
30%

AP didn't report what the other 28% felt -- we'll assume they are not changing their current practice. (Note: the 2% who will completely stop represents a single doctor.) Certainly doesn't look like a growth market, and Merrill downgraded Boston Scientific which derives significant percentage of its income from drug-eluting stents. Johnson & Johnson was not downgraded -- it's a bigger company and Cordis is just one division

Another poll currently being conducted on the professional cardiology site CRTonline asked its members what their current understanding of the DES thrombosis data was, and after the first two days (less than 100 total votes), the rough results were:

Cypher & Taxus DES both have more thrombosis than bare metal stents
45%
Cypher has more thrombosis than Taxus
15%
Taxus has more thrombosis than Cypher
20%
DES and BMS are the same
20%

The messaging that DES and BMS are pretty much the same in terms of late stent thrombosis seems to have little traction. In fact, Boston Scientific revealed last month that their internal data review showed a slightly higher rate for the Taxus, when compared to bare metal stents.

The third poll was taken on theheart.org, another professionals-only site. Here, doctors were asked if they thought angioplasty and stenting were "grossly overused" in treating patients with stable angina, and here the results of over 1100 voters were pretty striking:

YES: grossly overused
71%
NO: not grossly overused
29%

Now these are unscientific surveys, two of them with very small numbers. But add to the mood glimpsed in these polls the fact that special sessions on Late Stent Thrombosis have quickly been organized at upcoming national interventional meetings. Lenox Hill's NY-ACE meeting is next week and, as the first major U.S. meeting since the European Society of Cardiology (ESC) congress in Barcelona where all this recent thrombosis talk started, is sure to be host to some interesting discussions.

And two weeks later, a just-added special session has been announced for the Transcatheter Cardiovascular Therapeutics (TCT) meeting in Washington. The hour-long session includes a "Roundtable Discussion with physician scientists, industry and FDA" and is titled the "Stent Thrombosis Hot Line" which will address the "ESC Firestorm" -- do I feel the temperature rising?

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