Stents coated with a protective drug work better after three years than the older, un
coated devices in keeping arteries open and preventing heart problems and death, claims a European study.
What Is A Stent?
A stent is a flexible metal tube that is implanted to keep blood vessels from closing again after the artery-opening procedure called angioplasty.
Bare-metal stents were the first to be used, but they have largely been supplanted by coated stents, which made their appearance a few years ago. Drug-coated stents slowly release medication designed to keep the blood vessel from reclosing.
The new report comes from cardiologists at the Clinique Pasteur in Toulouse, France, who tracked 238 men and women, with an average age of 60 years, who had experienced a blockage in a single coronary artery.
The advantage of the coated stent was apparent almost immediately.
Of the 113 patients who got a coated stent, more than 99% survived for one year without needing a second angioplasty. This compared with almost 76% of the 114 patients who got bare-metal stents.
After three years, only 15.8% of the patients who got the coated stent had died, had another heart attack or artery-opening procedure, compared with 33.1% of those who got a baremetal stent, say the researchers.
"Now, it has been confirmed that you have a therapy that is extremely effective both in the short term and in the three-year term," says Dr. Alexandra Lansky, associate professor of medicine at Columbia University Medical Center in New York City.
One reason why the longer-term results are important is that "historically, with any therapy that shows benefit in the short term, you might see an erosion of its effect over time," Lansky says. "It was important to show that these results are durable."
"We have been looking at alternatives to surgery." Lansky adds. "Now that we have results that are durable, this could provide an alternative to bypass surgery."
A Different Opinion
However, Dr. Warren K. Laskey, chief of cardiology at the University of New Mexico, says he still uses bare-metal stents in some cases, although only for a small percentage of patients. These are patients who might have a problem with Plavix, a blood-thinning drug prescribed for patients getting coated stents but not for those getting the bare-metal kind, he says.
Laskey adds a note of caution in interpreting the results of this study. "The patients who are put in these trials are the best cases, ideal cases, not always typical of what is happening in the real world, where people are older and sicker for a lot of reasons. We need to keep in mind that...there might not be as rosy a situation for real-world patients," he cautions.