Safety of Drug-Eluting Stents - Introduction - One Year after the World Congress of Cardiology 2006

Introduction

Welcome to the Webcast of the Cordis Satellite Symposium at ESC Congress 2007 entitled “Safety of Drug-Eluting Stents - One Year after the World Congress of Cardiology 2006” , held on Tuesday 4th September 2007.

This Webcast and the Satellite Symposium have been brought to you under the auspices of the Cordis Cardiac & Vascular Institute (CCVI), which is a Global Network of expertise dedicated to advancing Cardiac and Vascular Care supported by Cordis, a Johnson & Johnson company, for the benefit of physicians around the world.

The program of the Symposium covers the ongoing issues relating to the safety and efficacy of Drug-eluting Stents (DES) in the real world of practical intervention. It is co-chaired by two of the world's most eminent Interventionalists, Philip Urban and Patrick Serruys, and has a faculty of well known opinion leaders in Christian Spaulding, Michael Maeng, Stephan Windecker and Keith Dawkins.

DES are safe in challenging indications: diabetes, small vessels, and acute MI
*Christian Spaulding*
	Patients with acute myocardial infarction (AMI) were excluded from the pivotal studies on sirolimus-eluting stents (SES). Three dedicated studies on the use of SES in AMI were recently published and showed positive results. A look at the TYPHOON, SESAMI and STRATEGY clinical trials with a particular emphasis on the safety issues around stent thrombosis with DES and the differences seen between SES and bare metal stents (BMS). What is the current status of this controversial issue?

DES are safe in real-world patients. Results from the Western Denmark Heart Registry
*Michael Maeng*
	Coronary DES implantation is increasingly used for coronary revascularisation and has resulted in improved clinical outcome with reduced target lesion revascularisation (TLR). However, the long-term safety of DES implantation is a crucial question. Recently, a large (over 12,000 patients) Danish registry study (Western Denmark Heart Registry) was published in the Journal of the American College of Cardiology. Here outcomes were compared in patients treated by balloon angioplasty with or without stent (BMS, SES and paclitaxel-eluting stents (PES)) implantation followed over a 15 month period. Does this minor risk outweigh the advantages of DES?

Comprehensive update on safety and efficacy of established DES
*Stephan Windecker*
	Numerous clinical studies and systematic reviews have established that 1st generation DES reduce angiographic restenosis by 60-80% and the need for repeat revascularisation procedures by 50-70% compared with BMS. More recently, the safety of DES has been called into question related to concerns of very late stent thrombosis (ST). Case reports, observational studies, extended follow-up of trials comparing DES with BMS, and meta-analyses of randomised trials suggested that very late ST (>1 year after stent implantation) was more common with DES than BMS. But what has been the influence of off-label usage?

DES in Multivessel Disease are a safe alternative to CABG. Future developments of the Conor Reservoir Technology
*Keith Dawkins*
	In recent years, the introduction of intracoronary stenting has added a new dimension to the management of patients with multi-vessel coronary artery disease (CAD) . In particular, the development of DES may have tipped the balance in favour of minimally-invasive percutaneous coronary intervention (PCI) treatment strategies when compared to the conventional surgical options represented by coronary artery bypass grafting (CABG) – both in terms of efficacy, and more particularly, safety. Where are we now and where will developments go?