Study: Drug-coated stents save lives

Drug-coated stents cut death rates for heart attack victims by 16 percent over older, bare-metal versions, according to a study in the New England Journal of Medicine, offering fresh evidence about their safety.

Sales of drug-covered stents fell 30 percent last year, amid concern drug coatings could lead to fatal clots. The study suggests there's less to fear from the new stents in patients who've already had heart attacks, said Laura Mauri, its lead author.

The study, funded by the Massachusetts Department of Public Health, tracked 7,217 heart attack victims given stents. Among those with drug-coated versions, 10.7 percent died within two years, compared with 12.8 percent who had bare-metal devices.

Of the 1 million stents implanted in US patients annually, about half are used for heart attack victims. The drug coating is intended to prevent scar tissue from reclogging arteries.

Patients with drug-coated stents also suffered fewer repeat heart attacks and were a third less likely to need a second operation to reopen a clogged artery, according to the research.

Stent makers, led by Natick-based Boston Scientific Corp. and Johnson & Johnson, of New Brunswick, N.J., sold $5.4 billion worth of drug-coated stents in 2005. Revenue fell to $4.15 billion last year, according to Wachovia Capital Markets. Doctors have been returning to the devices this year as new research downplays the safety risks.

But another report, also released yesterday, may pose a challenge for Boston Scientific and the other stent makers.

According to the American Heart Association, the surgery to open an artery so a stent can be implanted adds $10,125, on average, to a patient's medical bill without significantly extending life or improving health for someone with so-called stable angina - chest pain in patients who have not had a heart attack that can be treated with drugs, diet changes, and exercise.

Angioplasty is performed on more than 800,000 US patients a year, at a cost of about $10 billion. Half are done to treat stable angina.

The procedure costs $34,843, including follow-up care. That compares with $24,718 for a regimen of anticholesterol medicines and lifestyle changes, researchers reported in the journal Circulation: Cardiovascular Quality and Outcomes.

The study has limitations, such as its use of older devices, that make its implications unclear, said cardiologists Ajay Kirtane and David Cohen, in an editorial. The study tracked only patients given bare-metal stents. Drug coatings on newer stents block scar tissue and would quite likely increase the stents' benefits, Kirtane wrote.