Story Published:
Sep 3, 2006 at 5:22 PM PST
Story Updated:
Aug 31, 2006 at 7:36 AM PST
BARCELONA, SPAIN - Experts expressed concerns Sunday that
drug-coated heart stents - metal-mesh tubes used to prop open
coronary arteries - may in rare instances lead to potentially fatal
blood clots.
Studies released Sunday at the World Cardiology Congress in
Barcelona raised new concerns about the risks that may accompany
the drug-coated stents, which were introduced in 2000 as an
improvement on bare-metal stents.
Nearly 6 million people worldwide now have the drug-lined
versions. The devices are intended to keep arteries open after
having been cleared of fatty deposits and are often credited with
saving patients from future heart attacks or bypass surgery.
A Swiss-Dutch study tracked 8,146 patients and found that
recipients of drug-coated stents were at increased risk of
thrombosis, or blood clots, that can occasionally result in death.
Two other Swiss studies, analyses of presented and published
information discussed at the cardiology conference, also found that
first-generation drug-coated stents had higher links to thrombosis
compared to bare metal stents.
In bare metal stents, heart cells naturally grow to cover the
stent, providing a natural biological lining. But in the
drug-coated versions, the drugs prevent tissue growth - which is
both their intent and their possible downfall.
Drug-coated stents were previously viewed as a great advance
since the drugs they emitted prevented cells that could block the
arteries from growing. A thick growth of cells is undesirable, but
a thin layer of cells lining the artery is essential. In some
instances, drug-coated stents have prevented this minimal
protective cell layer from growing, leaving exposed metal, which
essentially can act as a clot magnet.
"This is potentially explosive information," said Dr. Steven
Nissen, president of the American College of Cardiology and
director of cardiology at the Cleveland Clinic.
"It certainly makes me pause with substantial concern," said
Nissen. He said there is already a shift in the U.S. away from
using drug-coated stents in favor of their uncoated predecessors.
Doubts about drug-coated stents were initially raised in March
by a small-scale Swiss study, though there have long been naysayers
about their potential adverse effects. Results from the Swiss-Dutch
study found that the incidence of thrombosis does not diminish as
time passes.
Researchers found that the possibility of thrombosis continued
to pose a risk, though minimal, during the first three years
following stent implantation. Other issues, however, such as
patient compliance with taking prescribed medications, may play a
role in blood clot formation.
Some medical experts worry that the financial implications of
reducing usage of the profitable drug-coated stents may be taking
priority over improving patients' health.
"It's time to stop and re-evaluate," said Dr. Salim Yusef,
professor of medicine and director of cardiology at McMaster
University, Hamilton, Canada.
"Having done six million of these procedures, isn't it a
terrible indictment on us that we don't have long-term safety data
on these?" he said.
The drug-coated stent market last year was estimated as being
worth more than $5 billion, and is dominated by Boston Scientific
and Johnson & Johnson. Drug-coated stents are also far more
profitable, selling for about $2300 each compared to the cheaper
$700 bare metal versions.
While significant, these new findings are not expected to
radically alter the use of drug-coated stents in the immediate
future.
"This won't change clinical practice right now, but it shows us
that this a problem that needs to be investigated with larger
trials," said Dr. Raymond Gibbons, president of the American Heart
Foundation.
Nissen, however, was more skeptical.
"There is a tendency for physicians to switch practices even
before data is solid," he explained. "If there's a suspicion, why
take the risk?"