Drug-eluting stents dealt another blow to their bare-metal cousins by leading to fewer adverse events post-procedure in patients over the age of 85 undergoing percutaneous coronary intervention, new research shows.
Patient with drug-eluting stents showed a 29% mortailty risk, compared with a 38% risk in patients with bare-metal stents, with the difference narrowing with increasing age, according to the study, published in the Journal of the American College of Cardiology.
Researchers aimed to examine the comparitive effectiveness of stent types for the older patients, a group which is often ignored in stent research, MedPage Today (registration) reported.
They found that rehospitalization due to heart attack was significantly lower among patients with DES (9%) compared to the bare-metal stents (12%).
DES demonstrated lower reshospitalization risk for all age groups in the CathPCI Registry, the largest U.S. registry for PCI patients with more than 471,000 individuals aged 65 and older enrolled across 947 sites. The difference in rehospitalization rate narrowed for younger patient groups.
Bare-metal stents proved to result in lower revascularization risk and bleeding risk was similar across the board.
The battle continues over the use of DES and bare-metal stents. A study published in the journal Circulation last August called bare-metal stents a more cost-efficient treatment option, offering an average of about $400 in savings per patient without significantly increasing adverse health outcomes.
DES use decreased from 92 percent to 68 percent between 2004 and 2007, according to the study, but adverse events related to stent procedures remained largely unchanged.
Catheter ablation remains problematic for atrial fibrillation
Catheter ablation procedures abound with complications and frequent rehospitalization when used as a treatment for atrial fibrillation, another recent JACC study found.
Nearly 1 in 10 patients among more than 4,150 who underwent the proceure in a Stanford University study were rehospitalzied within a month, and 1 in 20 developed complications including bleeding and perforation, MedPage Today (registration) reported.
The procedure "has offered the promise to free patients of symptoms of palpitations, dyspnea, and fatigue," Oakland University William Beaumont School of Medicine’s Dr. David Haines wrote in a note accompanying the study. "These advantages are compelling, and they explain the wide adoption of a procedure that is technically challenging and has results that can be characterized as mediocre at best."
The FDA cleared AtriCure’s (NSDQ:ATRC) Synergy radiofrequency ablation system for atrial fibrillation mid-December, covering treatment for patients with "persistent and long-standing persistent AF during open-heart concomitant coronary artery bypass grafting and/or valve replacement or repair procedures," according to a press release.
Two months earlier the watchdog agency put a hold on Medtronic’s (NYSE:MDT) cardiac ablation device, saying that it’s decision was not meant as a “no” but as a “not yet,” citing a failure to meet safety endpoints in clinical trials.
TAVI works better with more selective patient enrollment
Using angiographs and computed tomography to better select patients for transcatheter aortic valve intervention procedures led to a significant reduction in adverse events, researchers found.
Vascular complications following TAVIs dropped from 32% to 9% from 2009 to 2010, during which time improvements were made in TAVI instruments and vascular repair techniques became more common as well, MedPage Today (registration) reported.
"Open surgical access and closure of the femoral artery has been advocated to reduce complication rates when using the large sheaths required for [TAVI]," according to the study, published in the latest issue of the JACC. "However, this study suggests that with careful patient selection and advanced interventional techniques, very low complication rates can be achieved with a fully percutaneous procedure."
The study considered 137 patients at a single site with an average age of 83, and the most commonly used valve was Edwards Lifesciences Corp.’s (NYSE:EW) Sapien XT.
Recent Mayo research suggests that it may take as many as 30 procedures for a physician to become proficient at transcatheter aortic valve implantation.