Newer drug eluting stents (DES) are proving to be significantly more effective and safer compared to the 'first-generation' drug eluting stents. DES is developed to reduce incidents of re-blockage or restenosis which occur with bare metal stents and almost all trials showed a marked reduction in restenosis rates. The ideal drug eluting stent is one which demonstrates high efficacy while maintaining excellent safety profile.
The latest stents made of polymer and steel are known for higher biocompatibility. These are thinner in appearance and more flexible. The lower doses of the drug are much preferred as a long treatment option for complex and difficult cases. Another big advantage is the negative side effects. The drug eluting stents reduced the need for a second intervention procedure by about 40 to 50 per cent compared to bare metal stents especially in complex cases where patients reported long blockages in diabetics and those having small blood vessels, according to Dr Mitchell Krucoff, interventional cardiology scientist and advisor to US FDA on medical devices.
Dr Krucoff who is in India to research on medicine, healing and spirituality at the Satya Sai Institute of Higher Medical Sciences in Bangalore, said that over 75,000 patients are treated with drug eluting stents each year in India. The ideal drug eluting stent is one that has proven in large clinical trials to reduce the chances of reblockage, morbidity and mortality.
According to the recently concluded international congress of interventional cardiology, Transcatheter Cardiovascular Therapeutics (TCT), in San Francisco, three separate large randomized clinical studies showed that the new generation drug eluting stent Xience V was significantly more effective and safe than the first generation Taxus stent.
India will account for 60 per cent of the global heart disease burden in the next few years, reports a recent study by a team of Indian and Canadian researchers. Indians have a genetic disposition to heart disease and develop disease earlier in their life compared to western population. Already the country set to become the diabetes capital of the world and it is forecasted that it will also be known for the highest incidence of heart disease, said Dr Krucoff.
Due to the effectiveness of stents, angioplasty is becoming the preferred choice of treatment of patients with narrowing of the blood vessels in the heart. These devices have evolved over the last two decades beginning from specialized balloons mounted on catheters to treat the narrowing to bare metal stents to drug coated stents. In India, use of drug eluting stents have increased dramatically since their introduction in 2003.
Going by the economies of scale, DES is being preferred to by-pass surgery in terms of faster recovery and higher productivity for the patient to get back to work at quicker pace, he added.
Interventional cardiology is a super specialty and the need of the hour is adequate number of trained experts. If there are specialists who have ample experience, they are most-sought after experts to implant DES. The number of cath labs should also increase to help specialist carry out the procedure. India is far higher in terms of expertise and use of stents than China. The country has a growing patient population who need DES which are affordable, said Dr Krucoff.