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?
|