Two years ago at the European Society of Cardiology annual congress in Barcelona, the safety of drug eluting stents was questioned in a presentation by Dr. Camenzind. He had performed an analysis of several randomized trials on drug eluting stents (DES) vs. bare metal stent (BMS) and concluded in an excess in mortality and myocardial infarction due to late stent thrombosis. Last year, at the annual meeting in Vienna, already a comprehensive overview in a main session entitled “One year after Barcelona” weakened this message. Today’s main session intended to update the audience on this subject.
Prof. Harrington from Durham dealt with the subject of registries on DES. At the beginning of his lecture, Prof. Harrington informed us that after the initial storm in Barcelona in 2006, the use of DES decreased from 80% to 60% in his country. Although randomized controlled trials remain the standard in clinical research, registries remain essential to counterbalance the limitations of randomized trials.He gave a complete overview of most of the registries in the field of DES, concluding that at present, DES do not increase mortality compared to BMS, even in off label indications.
See R. A. Harrington presentation online
The second lecture was given by Prof. Kastrati from Munich on an update of randomized trials. Briefly, data and in particular meta analyses consistently demonstrate the safety and efficacy even of first generation DES. Still, he indicates that further improvement can be achieved by technology.
See A. Kastrati presentation online
The third speaker, Prof. Di Mario from London, clarified the indication for use of DES. There are probably no more absolute angiographic contra indications for their use. He noted that saphenous vein grafts and primary PCI need further investigation and a tailored approach. He stressed the point that the major contra indications relate to ability to prescribe accurately antiplatelet therapy, therefore nicely introducing the topic of the last speaker.
Finally, Prof. Jaffe from Haifa dealt with the important issue of antiplatelet therapy after DES placement. Dual antiplatelet therapy by aspirin and clopidogrel should be prescribed for at least 12 months. He quoted a few trials on monitoring of antiplatelet therapy and trials on new antiplatelet drugs such as prasugrel. Monitoring may be indicated in particular in high risk patients and prasugrel may also have a role in this high risk group.
See R.Jaffe presentation online
Notes to editor
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.