Drug eluting stents fail in crucial board EXAMINATION !
Posted Aug 31 2011 3:39am
Interventional cardiologist are excessively talented guys .They always lead ahead in innovations .The only issue is , their enthusiasm ( Or is it craziness ? ) many times overtake the pace of science . In the name of off label indications they indulge in drug and device extravaganza in uncharted territory .
Even as we boast of practicing evidence based cardiology we indulge in scientific adventures without proper evidence and rather wait for evidence to come later .” A clear case of cart pulling the horse “
The wide-spread of use of second generation DES in STEMI has not been found to superior to BMS in the EXAMINATION trial just released in ESC 2011 Paris. It failed miserable when every one took the superiority for granted.( Some may claim non inferiority is not a failure , but for a DES which was perceived a revolution, it is definitely a failure in the STEMI subset )
Further, what EXAMINATION trial did not address is a well known issue , acute and sub acute stent thrombosis .Even as the DES is credited with a dubious record for sub acute stent thrombosis , there is every reason to suspect , in the milieu of STEMI the thrombotic risk of DES would increase many fold.
The seemingly low incidence of stent thrombosis with DES in STEMI , in EXAMINATION trail is a statistical mirage .This trial was neither planned nor powered to address the issue of stent thrombosis.
In the ultimate analysis of EXAMINATION , One could conclude Cobalt chromium BMS, has cemented its place , more firmly for use in primary PCI.
DES at best ( *With all those conditions apply , Dual antiplatelet etc) can be equal to BMS, while BMS at any day , would casually will win over DES without any conditions at a huge cost advantage.
The above analysis is diagonally opposite to that of general perception that emanated from Paris ESC meet 2011 trial .
Still , there is a strong point here .What do you think ?