tag:blogger.com,1999:blog-7378369435453372603.post5203156132730389718..comments2023-10-21T11:53:54.366-03:00Comments on blog do Paulo Lotufo: Guerra dos stents: perda para os dois lados.Anonymoushttp://www.blogger.com/profile/00246144050660663066noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-7378369435453372603.post-26977723554867545382006-09-10T11:44:00.002-03:002006-09-10T11:44:00.002-03:00Safety of drug-eluting stents: insights from meta ...Safety of drug-eluting stents: insights from meta analysis.<br>A meta-analysis of first generation drug eluting stents - including both first generation drug eluting stent extent of both mortality and Q-wave Myocardial Infarction in comparison to bare metal stents. Here the presenter Edoardo Camenzind (Geneva, Switzerland) and the discussant Alain Nordmann (Basel, Switzerland) provide an overview of the results.<br>Introduction<br>First generation drug eluting stents (1stg-DES: sirolimus eluting stent [SES] have been widely accepted and are used for a large spectrum of clinical indications.<br>Recently case reports and autopsy reports have been published on single cases as well as on series of cases which experienced stent thrombosis more than 30 days after stent deployment, so called late stent thrombosis. Delayed healing and diminished antiplatelet therapy could be demonstrated as relevant precipitating factor.<br>The global incidence of ‘in-1st g-DES’ thrombosis according to the literature remains uncertain. According to some single center registries and post-marketing surveillance registries as well as meta-analysis the incidence of late angiographic stent thrombosis does not seem to be higher in 1st g-DES as compared to bare metal stents (BMS). However according to the recently presented BASKET-Late trial, a small randomized trial designed to evaluate cost effectiveness of 1st g-DES versus BMS, severe cardio-vascular events were significantly higher in patients with 1st g-DES as compared to BMS in the year following the interruption of dual antiplatelet therapy.<br>Methods<br>The current analysis embraced both 1st g-DES clinical programs (SES and PES) and included all available data concerning company supported randomized double-blind clinical trials comparing 1st g-DES to the respective BMS control. Of the SES program the following trials were included: RAVEL, SIRIUS, E-SIRIUS and C-SIRIUS and for the PES program: TAXUS II, IV, V and VI accounting for a total of n=878 SES vs n=870 BMS and n=1685 PES vs n=1675 BMS. Available randomized trials’ data within a specific study program (SES or PES) were stratified by trials and data of the same time-periods of follow-up were pooled as well as data of the latest available follow-up.<br>The clinically oriented analysis focuses on death, Q-wave MI and death and Q-wave MI combined thought to reflect the incidence of stent thrombosis best instead of using restrictive thrombosis definitions (e.g. late angiographic stent thrombosis). <br>Results<br>The incidence - up to the latest available follow-up - of total mortality and Q-wave MI combined were 38% (SES) and 16% (PES) higher in 1st g-DES as compared to control BMS (p-value: SES vs BMS: 0.03 ; PES vs BMS. 0.68).<br>Conclusion <br>eath and Q-wave myocardial infarction have a higher incidence in 1st generation drug eluting stents as compared to the bare metal control stents. <br>Thus the indiscriminated use of 1st g-DES should be avoided and the use of bare metal stent may still be maintained awaiting for safer 2nd g-DESAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7378369435453372603.post-68878212521412418432006-09-10T11:44:00.001-03:002006-09-10T11:44:00.001-03:00DES versus BMS: an evidence-based approache to ste...DES versus BMS: an evidence-based approache to stent selection in real-world" patients -18 month update of BASKET."<br>The BASKET study, presented in clinical trial update session I, identifies that to achieve optimal benefit drug eluting stents could be restricted to small vessels less than 3mmm and bypass grafts. Here presenter Christoph Kaiser (Basel, Switzerland) and discussant Jean Marco (Toulouse, France)provide an overview of the results. <br>Background <br>In order to define patient subgroups with a particularly high versus no or only minimal clinical benefit from DES compared with BMS use we anlayzed our “real-world” experience from BASKET after 18 months.<br>Methods<br>BASKET included 826 consecutive patients with PCI and stenting irrespective of indication. Patients were randomized 2:1 to DES versus BMS and followed up for 18 months for the occurrence of major adverse cardiac events (Cardiac death, non-fatal MI and non-MI related TVR). Based on tests for interaction with the different stent types, patient subgroups with high versus low clinical benefit from DES were identified.<br>Results<br>Overall, event rates were low (DES vs. BMS: Death/MI: 8.4% vs. 7.5%; (p=0.63); Non-infarct related TVR: 7.5% vs. 11.6% (p=0.05); MACE: 15.8% vs. 18.9% (p=0.26). Overall, only bypass graft interventions and small vessel stenting < 3.0mm showed significant interactions between stent type and non-infarct related TVR as well as Death/ MI or MACE. Therefore, we analyzed outcomes in patients with versus without these two characteristics. Kaplan-Meier survival curves showed a highly significant benefit of patients with small vessel/stent or bypass graft PCI from DES use (Fig. 1). In contrast, for all other patients there was no benefit of DES compared to BMS.<br>Conclusion<br>Based on evidence from this long-term follow-up from BASKET, DES may be restricted to small vessels/stents <3mm and to bypass grafts for optimal and long-term benefit. These findings challenge the notion that today every patient should receive DES irrespective of baseline characteristicsAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-7378369435453372603.post-27710834670082730452006-09-11T14:24:00.000-03:002006-09-11T14:24:00.000-03:00Top U.S. cardiologist calls for sweeping stent stu...Top U.S. cardiologist calls for sweeping stent study<br>Mon Sep 11, 2006 8:22am ET<br>Health News<br>New TB strain could fuel South Africa AIDS toll<br>China AIDS policy must be matched by enforcement: U.N.<br>World Bank, Gates probe Africa private health care<br>More Health News... Email This Article | Print This Article | Reprints [-] Text [+] <br>CHICAGO (Reuters) - One of the nation's leading cardiologists is calling for a sweeping study that evaluates the risks of potentially fatal blood clots related to widely used heart devices that treat blocked heart arteries.<br><br>Nearly 6 million heart patients worldwide have received a so-called drug-eluting stent, a tiny wire mesh tube that is covered with a drug that reduces scar formation and keeps vessels from reclosing.<br><br>But there has been a growing body of evidence that this newer generation of stents, compared with the bare metal variety, may cause blood clots to form long after implantation. Known as late-stent thrombosis, the risks were the center of debate at a cardiology meeting earlier this week in Barcelona.<br><br>"This really shakes up the whole cardiology community," Dr. Stephen Nissen, head of cardiovascular medicine at the Cleveland Clinic, said in a telephone interview.<br><br>"No one has done the right kind of long-term study," he said, adding that patients should be followed for three or four years instead 9 months. "We need a prospective, randomized trial. That's the gold standard and I'm hoping regulators will mandate it."<br><br>He said he will take an active role in initiating such a study. "How else will we answer the question?" Nissen added.Anonymousnoreply@blogger.com