PCI guideline update stresses long-term therapy after DES

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Patients treated with drug-eluting stents must take a combination of aspirin and the clot-reducing drug clopidogrel for at least one year, and possibly longer, after stent implantation. This is one guideline update jointly published in the journals of the American College of Cardiology (ACC), the American Heart Association (AHA) and the Society for Cardiovascular Angiography and Interventions (SCAI).

“For most patients suffering a heart attack, angioplasty and implantation of a stent is a life-saving procedure,” said Bonnie Weiner, MD, SCAI president. “However, both patients and the medical community need to understand how essential dual anticoagulant therapy is after receiving a drug-eluting stent (DES). That’s the purpose of this update – to stress this and other evidence published relatively recently.”

The update specifically addresses findings from studies published through late 2006. One of the concerns that arose during the period was about a slightly higher risk of blood clots forming inside DES.

“By emitting tiny amounts of medication, DES reduce the regrowth of scar tissue and other build-up that could renarrow the artery, creating a need for a repeat angioplasty,” explained Weiner. “While we don’t want to understate the precautions that should be taken to prevent clots, we also want to factor in the benefits of these newer devices.

The guideline update also considers Open Artery Trial (OAT) and the earlier Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) study, two randomized clinical trials that looked at whether to open totally blocked arteries in patients who had suffered a heart attack between three and 28 days earlier.

“OAT looked at patients with a completely blocked artery who had suffered a heart attack between 72 hours and 28 days earlier but had neither serious chest pain nor evidence of ischemia,” said Weiner. “Considering the findings of ICTUS, the writing committee suggests that in patients with unstable angina or the milder form of heart attack known as non-ST-segment elevation myocardial infarction, risk stratification is critical to determining the optimal approach to patient care and that coronary angiography and PCI improve outcomes in high-risk patients.”

The update also strengthens the earlier guideline’s recommendations about smoking cessation, exposure to second-hand smoke, medical management of high cholesterol and high blood pressure and coordinated care of diabetic patients. The update does not address in detail when PCI should be used for patients with chronic stable angina. The more recent studies addressing this issue are still being tested in ongoing studies and debated in the medical literature.

In order to access the “2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention,” visit SCAI’s journal, Catheterization and Cardiovascular Interventions.