Cardiovascular Business - January/February 2009 - (Page 17)

“Clearly, there are diabetic patients with multivessel disease that can be treated appropriately with angioplasty—not all, but some.” david O. Williams, Md, chief of interventional cardiology at Rhode island Hospital in Providence than non-insulin-dependent diabetic patients,” Mehran says. Since then, the ARTS trial found no significant difference at five years in mortality and incidence of stroke or MI between stenting (BMS) and CABG in the study population of 1,200 patients with multivessel disease. Overall MACCE was higher in the stent group, driven by the increased need for repeat revascularization (J Am Coll Cardiol 2005; 46[4]:575-81). A subset analysis of the 208 diabetic patients found a higher mortality rate in the stent group compared to the CABG group. Researchers also found that diabetics treated with stenting had a lower event-free survival at five years compared with non-diabetic patients, but the study was not powered to show mortality differences between diabetic and non-diabetic patients. Researchers suggested that differences in outcomes seen between BMS versus CABG for the treatment of multivessel disease are likely to narrow substantially with the advent of DES. More recently, the HORIZONS AMI trial, which had a diabet- ic population of 16.5 percent—approximately 600 patients— and used DES, showed a benefit for diabetics who were on the anticoagulant bivalirudin (Angiomax). For the diabetic population, there was no interaction between heparin strata and bivalirudin safety and efficacy in this trial both at 30 days and at one year. Overall, the trial, which examined 3,600 STEMI patients, showed that diabetic patients fared much worse—higher bleeding complications, more net adverse clinical events, as well as higher mortality rates—than nondiabetics, which Mehran defines as “expected results.” While some pooled analyses have indicated that patients with diabetes do better with the glycoprotein IIb/IIIa inhibitor abciximab (ReoPro), “we didn’t find that with HORIZONS AMI,” Mehran says. The subgroup analysis of the diabetic population of both the SYNTAX and CARDia trials found that there was no difference for death, MI or stroke compared to bypass surgery and stenting with DES. There were more incidents of revascularization in > Choosing the Right Stent: A QUICK LOOK at Drug-Eluting Stents* ■ Abbott Vascular’s Xience V everolimus-eluting coronary stent system (also called Promus and sold by Boston Scientific) is indicated for improving coronary luminal diameter in patients with symptomatic heart disease due to de novo native coronary artery, lesions (length ≤28 mm) with reference vessel diameters of 2.5 mm to 4.25 mm in diameter. Boston Scientific’s Taxus Express paclitaxel-eluting coronary stent system is indicated for improving luminal diameter for the treatment of de novo lesions ≤28 mm in length in native coronary arteries ≥2.5 to ≤3.75 mm in diameter. Cordis’ Cypher sirolimus-eluting coronary stent is indicated for improving coronary luminal diameter in patients with symptomatic ischemic disease due to discrete de novo lesions of length ≤ 30 mm in native coronary arteries with reference vessel diameter of ≥2.5 mm to ≤3.5 mm in diameter. Medtronic’s Endeavor zotarolimus-eluting coronary stent system is indicated for improving coronary luminal diameter in patients with ischemnic heart disease due to de novo lesions of length ≤27 mm in native coronary arteries with reference vessel diameters of ≥2.5mm to ≤3.5mm in diameter. ■ ■ ■ * Material gathered from Fda-approved indications. CardiovascularBusiness.com Cardiovascular Business 17 http://www.CardiovascularBusiness.com

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2009

Cardiovascular Business - January/February 2009 Contents First Word Electrophysiology Roundtable Forum: A Candid Conversation about Profits, Procedures and Patients Heart Failure Care Gets Boost from Technology Emerging Technologies in Peripheral Vascular Interventions Stent vs. Graft: Choosing the Best Path for the Diabetic Patient with Multivessel Disease Cardiology Groups and Hospitals Strive to ‘Connect’ Seamlessly CT Beyond 64 Slices Clinical Study Digest: Kidney Disease & PCI; Women and Valve Disease Compact Echo Systems Come Up Big in Cardiac Care News & Views Reader Resources The ACC Corner

Cardiovascular Business - January/February 2009

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