Its a funny world out there in medical science, more so in the field of cardiology ! A new treatment comes as a revolutionary breakthrough , lives merrily for a while . . . only to blink , few years down the lane . . . and make a sheepish exit !
Here comes some important knowledge from Rome , European society of cardiology conference 2016 .Its the much expected NORSTENT study from Norway,with a largest number (9013 patients comparing one to one BMS vs DES ) with up to 6 year follow up data ,exposing the limitations and the possible false superiority of DES over bare metal stents .It almost concludes there is no meaningful preference for DES over BMS in obstructive CAD in terms of survival .(ACS included)
For over a decade billions of dollars were drained with a hyped scientific concept of coating the stent with drugs to prevent restenosis . DES , was able to effectively pull the BMS down and out by statistics. This, in spite of the strong concern of DES, interfering with normal healthy endothelisation of the stented segment which resulted in unexpected sudden DES related thrombosis. The power of commerce is huge , it can finish of a useful modality,if available cheap.This happens even in a lesser developed country like India.
I guess,the obituary for BMS is already written in most part of the world. (I can vouch for it my city Chennai !) Now that NORSTENT has come out, though belatedly, I wonder any company wants to manufacture BMS in a big way ! Can it infuse a fresh life into BMS which I believe is surprisingly sitting alive in it’s graveyard .
Baremetal stents where are you ? My patients need you !
Counter thought and a rebuttal !
Many will say my interpretation of the NORSTENT study is wrong and its a indecent attack on a proven scientific concept of DES which is the only way to reduce restenosis rate.
But , what is the big deal in preventing restenosis,if DES doesn’t save significant lives ?
The argument that DES reduces repeat revascularisation is largely irrelevant as it amount to only angiographic gratification and reduced threshold for intervention and ultimately imply inappropriate re-intervention in the BMS group.(Only Clinical restenosis ie symptomatic, flow limiting stenosis require attention .We need that specific data from NORSTENT . )
Don’t believe blindly in whatever is written here .Read for yourself and decide ! The NORSTENT from Norway published in NEJM August 2016 http://www.nejm.org/doi/full/10.1056/NEJMoa1607991