Cost plays a role in his judgment, James said. "The prices of drug-coated stents have gone down in Europe, but they cost twice as much here [in Europe] as the bare-metal stents," he said.
And the study results are not definitive because they did not come from a randomized, controlled trial, the gold standard of medical research, James said.
The American study, reported in the same journal, was such a controlled trial. It included 3,006 people given stents after heart attacks, comparing outcomes for the 2,257 who got Taxus stents, coated with the drug paclitaxel, with the 749 who received bare-metal stents.
Unlike the Swedish trial, which was funded by governmental and noncommercial organizations, the American trial was supported by Boston Scientific, which markets the Taxus stent.
Again, the rate of re-stenosis was significantly lower in the group given a coated stent: 10 percent versus 22.9 percent in the first 13 months. There was an identical 12-month death rate, 3.5 percent, in both groups, and no difference in the incidence of serious cardiac problems, such as second heart attacks.
It's not surprising that there was no lifesaving benefit to the drug-eluting stent, said study author Dr. Gregg W. Stone, a professor of medicine at Columbia University Medical Center.
The procedure done in the study was the reopening of the blocked artery that caused the heart attack, Stone said. "What keeps them alive is whether or not they have another heart attack," he said. "We don't expect them [the stents] to save lives."
He was strict in drawing a conclusion from the trial: "What this study shows is that this paclitaxel-eluting stent is safe to use in patients with an evolving heart attack, and that it reduced the incidence of re-stenosis by about 40 percent."
That conclusion cannot be extended to other drug-coated stents because "drug-eluting stents are d
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