SCAI news: Drug-eluting stents prove mettle in heart attack patients

07/13/05

SCAI is pleased to bring to your attention two important articles published in the just-released issue of Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions (CCI)--

Drug-Eluting Stents Prove Mettle in Heart Attack Patients -- Drug-eluting stents are a safe and effective treatment for heart attack, provoking no increase in complications when compared to conventional stents ... Heart Attack Patients With Blockages in Bypass Grafts Face Poor Outlook -- The outlook is poor for patients who have coronary artery bypass graft surgery and later have a heart attack...

See the text below for details on both articles, or call 717-241-2470 or 717-422-1181 for copies of the articles themselves.

Drug-Eluting Stents Prove Mettle in Heart Attack Patients

Interventional Cardiologists and Patients Can Be Confident in New Treatment Choice

(BETHESDA, MD)--Drug-eluting stents are a safe and effective treatment for heart attack, provoking no increase in complications when compared to conventional stents and cutting the risk of arterial renarrowing by 90 percent. These are the findings of a new study published in the August 2005 issue of Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions.

The study fills an important information gap in the treatment of high-risk patients. Until now, patients with heart attack, or myocardial infarction, have been excluded from studies of drug-eluting stents. Physicians often use drugs and devices that have been approved in one group of patients to extend treatment to a new group of patients, however.

"There is increasing use of drug-eluting stents as the primary treatment for acute myocardial infarction. We wanted to know whether it was safe," said Ron Waksman, M.D., associate director of cardiology at Washington Hospital Center in Washington, D.C.

Drug-eluting stents are expandable metal tubes that prop open an artery supplying blood to the heart while slowly releasing a drug that over time prevents renarrowing, or restenosis. Drug-eluting stents were originally proved safe and effective in patients with simple arterial narrowings causing chest pain, not in patients with heart attack.

The new study involved 103 heart attack patients who were treated with the Cypher stent (Cordis Corp.). This stent is coated with sirolimus, a medication that prevents the overgrowth of scar tissue from the arterial wall into the center of the stent. Patients treated with the Cypher stent were compared to 504 heart attack patients who had been treated with a bare metal stent in the preceding five years.

Dr. Waksman and his colleagues found that treating heart attack patients with the drug-eluting stent was safe. There was no difference between the two groups in procedural complications. Another key finding: No patient developed a blood clot in the drug-eluting stent within a month of treatment, a serious complication known as subacute thrombosis. This is especially reassuring, given that heart attacks are themselves often caused by a blood clot, or thrombus, that blocks the artery following rupture of an inflamed plaque.

"When you have a group of patients who already have a thrombotic milieu, you want to make sure that you're not risking further thrombosis with the use of drug-eluting stents," Dr. Waksman said.

The study also showed that drug-eluting stents accomplished their primary purpose, preventing the need for a repeat procedure to treat renarrowing in the stented artery. At six-month follow-up, only 1 percent of patients treated with the drug-eluting stent required a new procedure to reopen the artery, as compared to more than 10 percent of patients treated with the bare metal stents.

"Our study reassures interventional cardiologists and patients that we have no reason to worry about using these stents in treating acute myocardial infarction. They appear to be safe--that's the most important thing--and also effective," Dr. Waksman said.

Dr. Waksman and his colleagues are considering conducting a head-to-head comparison of two types of drug-eluting stents in the treatment of heart attack: the Cypher stent and its competitor, the Taxus stent (Boston Scientific), which is coated with a different anti-renarrowing drug, paclitaxel.

Headquartered in Bethesda, Md., the Society for Cardiovascular Angiography and Interventions is a 3,400-member professional organization representing invasive and interventional cardiologists. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI was organized in 1976 under the guidance of Drs. F. Mason Sones and Melvin P. Judkins. The first SCAI Annual Scientific Sessions were held in Chicago in 1978.

To conduct an interview with Dr. Waksman, call 202-877-8575 or send an email to ron.waksman@medstar.net.

The Society for Cardiovascular Angiography and Interventions provides news reports of clinical studies published in Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions (CCI) as a service to physicians, the media, the public, and other interested parties. However, statements or opinions expressed in these reports reflect the view of the author(s) and do not represent official policy of SCAI unless so stated.

Heart Attack Patients With Blockages in Bypass Grafts Face Poor Outlook

Vein-Graft Blockages Signal Severe Disease That Challenges Even Coronary Interventions

(BETHESDA, MD)--The outlook is poor for patients who have coronary artery bypass graft surgery and later have a heart attack caused by blockage of the transplanted vein. Even after receiving the leading treatment for heart attack--a coronary intervention such as angioplasty or stenting--patients with vein grafts face a significantly higher risk of death than do patients whose heart attack resulted from a blockage in a natural coronary artery, according to a study in the August 2005 issue of Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions.

"Even after we fix these grafts, the long-term outlook is still limited. Once patients develop disease in the graft it, tends to progress, and that compromises long-term survival," said Bruce R. Brodie, M.D., who directs the LeBauer Cardiovascular Research Foundation in Greensboro, NC.

Dr. Brodie and his colleagues analyzed data from 2,240 heart attack patients who were treated with a catheter-based coronary intervention such as angioplasty or stenting. Of these, 57 patients had vein-graft blockages and the rest had blockages of a natural coronary artery.

The analysis showed that vein-graft patients were less likely to have brisk blood flow after coronary intervention (81 percent versus 94 percent) and more likely to die while still in the hospital (21 percent versus 8 percent). In addition, after five years, only 56 percent of the vein grafts were still open. After 10 years, fewer than half of vein-graft patients were still alive, as compared to 76 percent of patients whose heart attack was caused by blockage of a natural coronary artery.

Dr. Brodie said that the outlook is getting better, thanks to recent improvements in medications and the introduction of both drug-coated stents and devices to protect against blood clots that break loose during vein-graft procedures. Surgeons are also finding ways to expand the use of arteries rather than veins for bypass surgery. More needs to be done, however.

"We're treating more and more heart attack patients who have vein-graft blockages," he said. "The bottom line is, we need to look at new and better ways to restore blood flow to the heart in patients with advanced disease."

Headquartered in Bethesda, Md., the Society for Cardiovascular Angiography and Interventions is a 3,400-member professional organization representing invasive and interventional cardiologists. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI was organized in 1976 under the guidance of Drs. F. Mason Sones and Melvin P. Judkins. The first SCAI Annual Scientific Sessions were held in Chicago in 1978.

To conduct an interview with Dr. Brodie, call 336-832-8427.

Source: Eurekalert & others

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