Plus, underuse of aspirin after stent is “a travesty” says Mayo doctor
Cardiologists were urged to halt the "epidemic of madness" behind drug-eluting stent (DES) overuse, during an address by Salim Yusuf, M.D., McMaster University, Hamilton, Ontario, at the World Congress of Cardiology in Barcelona.
Meanwhile, other physicians focused on the efficacy of clopidogrel in preventing stent thrombosis during discussions of two meta- analyses and registry study, all of which showed an increase in mortality with DES, according to a report from heartwire.org.
While no clopidogrel data was provided in the meta-analysis presented by Dr Edoardo Camenzind (University Hospital Geneva, Switzerland), death and MI were strikingly higher in the patients on Cypher stents as compared with bare-metal stents, while there was no significant differences in these end points in the Taxus-treated patients compared with bare-metal stents.
Sigmund Silber, M.D., Dr Müller Hospital, Munich, Germany, said the disparity between Cypher and Taxus was attributable to the duration of clopidogrel – only three months in the Cypher studies compared to six months in the Taxus trials.
Another opinion was that meta-analysis is insufficient and just an impetus to do more randomized trials.
Less publicized portions of current studies, according to heartwire’s interview with Raymond Gibbons, M.D., Mayo Clinic, Rochester, MN, include the fact that 26 percent of patients in the Rotterdam/Bern registry study were not even on aspirin after undergoing stent implantation. "That is a clear violation of international guidelines," Gibbons stated. "That's what the story should be. . . . An unacceptable number of patients with known CAD are not taking aspirin. This is the single most cost-effective thing that we do in medicine, and it's a travesty that we're not doing better."
For more information, visit www.heartwire.org.