Confidence restored in heart stents

The stents, which slowly release drugs to stop blockages building up, had replaced bare metal stents as the most common percutaneous coronary intervention (PCI) strategy for treating coronary artery disease in Australia in 2005.

But data released at the 2006 World Congress of Cardiology in Barcelona suggested that DES were associated with higher mortality rates, shattering confidence in the new technology.

Professor Christopher Reid from Monash University and fellow researchers used data from the Melbourne Interventional Group (MIG) registry of PCI patients to evaluate the results of more than 9,000 PCI procedures over four years.

They found that while the use of DES declined steadily from 2004–2005 to 2007–2008, procedural success remained high and 12-month adverse outcomes remained low.

“In the current study, despite increasing patient risk profile and lesion complexity, highly selective use of DES in 32 per cent of PCI procedures in 2007–2008 achieved comparable low rates of adverse outcomes at 12 months to those seen with higher use of DES (54 per cent of PCI) in 2004–2005,” Prof Reid said.

In an accompanying editorial, Dr Christopher Hammett from the University of Queensland and colleagues said that the MIG figures gave a fascinating insight into physician behaviour.

“Confidence has been restored by evidence affirming DES safety, the introduction of ‘second generation’ platforms, and a better understanding of the importance of optimal medical therapy,” Dr Hammett said.

The safety and efficacy of DES were reaffirmed when analyses conducted after the 2006 Barcelona meeting showed they were not associated with an increased rate of myocardial infarction or death, but were associated with a reduction in need for revascularisation of up to 70 per cent compared with bare metal stents, Dr Hammett said.

In an accompanying article, Professor David Brieger from Concord Repatriation General Hospital and colleagues said that there had been a substantial improvement in outcomes for Australian and New Zealand heart patients from 2000 to 2007, accompanied by an increase in the uptake of evidence-based medical therapies.

The Medical Journal of Australia is a publication of the Australian Medical Association.

The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.

CONTACT:     Dr Christopher Hammett                                   0424 270 769

                    Mr Garry McAuley                                             07 3636 7863

                    Public Affairs, Royal Brisbane Hospital

                    Professor Christopher Reid                               0419 319 496

                    Professor David Brieger                                    0417 689 676