At this week’s annual European Society of Cardiology Congress in Rome, an important randomized clinical trial on stents was presented by Professor Kaare H. Bønaa, MD, PhD of the Clinic for Heart Disease, St. Olav’s University Hospital in Trondheim, Norway. Called NORSTENT, short for the “Norwegian Coronary Stent Trial,” this was the largest stent trial ever conducted, with 9,013 patients followed for six years. That’s serious! Continue reading
Category Archives: Bare Metal Stents
NORSTENT: Drug-Eluting Stents – Doing What They’re Supposed To
COURAGE: Does 15-Year Data Have Any Clinical Relevance?
This past week saw publication of an update to the 2007 COURAGE trial which compared optimal medical therapy (OMT) to stenting (PCI) as the initial management strategy for stable coronary artery disease. (Please note the phrase “initial management strategy.” This will not be the last time you see it in this post.)
Appearing in the New England Journal of Medicine and titled “Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease,” this study, performed by Dr. Steven P. Sedlis and other COURAGE trial investigators, is described as “an extended survival analysis to examine the potential long-term survival benefit from initial PCI among the patients with stable ischemic heart disease who were followed for up to 15 years after initial enrollment in the COURAGE trial.”
This new analysis concluded: “…we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease.” This also was the finding of the original COURAGE trial at five years. Continue reading →
Plavix and Aspirin After Stent: 8 Years Later – Is Longer Better?
No one thought it would take quite so long to get this information, but in just a couple hours results from the Dual Antiplatelet Therapy (DAPT) Study will be presented at the American Heart Association Scientific Sessions 2014. The question to be answered: Is there a benefit to extending dual antiplatelet therapy (aspirin plus a thienopyridine, such as clopidogrel/Plavix, prasugrel/Effient, etc.) beyond one year after stenting?
This is a question asked back in 2006, during a special two-day FDA hearing, convened to discuss all known issues with drug-eluting stents and prompted by the “ESC firestorm” over the problems of increased incidence of late stent thrombosis in drug-eluting stents. (See “Problems Resurface with Drug-Eluting Stents” – September 9, 2006.) Continue reading →
Meta-Analysis Shows Benefit of Drug-Eluting Stents vs BMS Below the Knee
Guest Post by Frank J. Criado, MD, FACS, FSVM, editor in chief of Vascular Disease Management.
(Editor’s note: this article is the first in a series of guest posts, a new collaboration between Angioplasty.Org and Vascular Disease Management.)
In the introductory remarks of “Meta-Analysis of Outcomes of Endovascular Treatment of Infrapopliteal Occlusive Disease With Drug-Eluting Stents,” lead author George A. Antoniou and his colleagues, from the Manchester Royal Infirmary in the UK, state that:
“Emerging evidence suggests that the combination of stenting and targeted delivery of drugs with antiproliferative properties, aiming to inhibit smooth muscle cell proliferation and intimal hyperplasia, improves the outcomes of endoluminal treatments of distal vessel disease. A small number of series have demonstrated satisfactory performance of drug-eluting stents, as expressed by increased patency and freedom from revascularisation to maintain good clinical results. Controversy exists, however, with regard to the superiority of drug-eluting stents over bare metal stents in terms of the clinical benefit in critical limb ischaemia patients.” Continue reading →
The Question of Angioplasty in the Elderly
We just posted a report on the XIMA Trial which studied stents in octogenarians. The trial compared drug-eluting with bare-metal stents and the results are very interesting: while the trial didn’t find a difference in these two types of stents for the pre-specified composite endpoint of death, heart attack, revascularization, stroke and major bleeding…it did find significantly lower incidence of revascularization and heart attack in those patients who received the drug-eluting Xience stent.
But the real take-away from the XIMA Trial is that stenting and angioplasty in the elderly is safe and effective. Mortality from cardiac causes in this trial was 4% at one year, no matter which stent was used. Continue reading →