Drug-Coated Stents Safest for Whom?
Study: Drug-Eluting Stents May Safely Trump Bare Metal Stents in Certain Patients
Oct. 3, 2007 -- The safety of drug-coated stents is back in the news, and
this time, the findings favor drug-coated stents -- at least, for some
A new study shows that patients who are the most likely to need follow-up
procedures after getting
stents may have the best risk-benefit profile for drug-coated stents.
"This is good news, reassuring patients and cardiologists about the
safety of drug-eluting stents when used in appropriate individuals,"
researcher Jack Tu, MD, PhD, says in a news release.
Tu works in Toronto at the Institute for Clinical Evaluative Sciences and
the University of Toronto. His study appears in tomorrow's edition of
The New England Journal of Medicine.
Confused about stents? Take a minute to get up to speed with the following
Stents are tiny metal mesh tubes that are inserted to hold open blocked or
narrowed coronary arteries.
The coronary arteries supply blood to heart muscle. If the coronary arteries
narrow, a heart attack becomes more likely.
Some stents are made of bare metal. Other stents are coated with drugs that
help prevent the stents from clogging up.
Recent research has raised
safety concerns about drug-coated stents (also called drug-eluting stents)
and the risk of blood clots, heart attacks, and death. The debate about that
risk is ongoing.
The new stent study is based on more than 7,400 Canadians who received
stents between December 2003 and March 2005.
Half of the patients received bare-metal stents. The other half received
The patients and their doctors made the decision about what type of stent to
get. They weren't assigned to get a certain type of stent.
All of the patients took a blood-thinning drug for a year after getting
Tu's team followed the patients for up to three years.
The patients who got drug-coated stents had a better survival rate than
those who got the bare-metal stents.
During the three-year study, 5.5% of patients in the drug-coated stent group
died of any cause, compared with 7.8% of those who got bare-metal stents.
The heart attack rate in the two years following stenting was similar for
both groups (5.2% of patients who got bare metal stents and 5.7% of those who
got drug-coated stents).
Sometimes, stented arteries become narrow again. The procedure of reopening
those arteries is called revascularization.
Among the Canadian stent patients, drug-coated stents reduced
revascularization, but only in patients with at least two of the following risk
- Skinny arteries (less than 3 millimeters in diameter)
- Long stretches of arteries that needed stenting
This study probably isn't the final word on the safety of drug-eluting
Tu's team calls for larger studies in which patients are assigned to get
bare-metal or drug-coated stents.
In the journal, one of Tu's colleagues -- the University of Toronto's Eric
Cohen, MD -- discloses grants and speaker's fees from Boston Scientific and
Cordis (a Johnson & Johnson company), which make drug-coated stents.