GLG News by Cardiologists (EU)

Goran OlivecronaConsulting CardiologistSkåne University Hospital

Are all statins equal ?

December 15, 2008

Analysis of:Patients Taking Lipitor Had a Significantly Reduced Risk of Cardiovascular Events Compared with Patients Taking Simvastatin, New Observational Study Shows | pharmalive.com

Retrospective studies should be viewed with caution. Most retrospective studies which may contain a bias in the prescribed treatment should be anlysed with matched propencity score. To confirm the results a randomized trial would essentially be needed.

Goran OlivecronaConsulting CardiologistSkåne University Hospital

A user friendly femoral access closure device with a fast learning curve

October 15, 2007

Analysis of:St. Jude Medical Announces Japanese Approval Of The Angio-Seal STS Plus Vascular Closure Device | www.medicalnewstoday.com

1. Angioseal is a very user friendly closure device which saves staff time spent with the patient and reduces he number of pseudoaneurysms, but it does not reduce the overall number of bleeding complications. 2. Angioiseal will probably continue to increase its market share in centers not moving to the radial access approach.

Goran OlivecronaConsulting CardiologistSkåne University Hospital

A new tool to improve survival rates in cardiac arrest victims?

October 15, 2007

Analysis of:Physio-Control Announces Availability Of LUCAS™ Chest Compression System In United States | www.medicalnewstoday.com

1. LUCAS can effectively sustain circulation in spite of cardiac arrest through external mechanical chest compressions thus maintaining a sustenance of blood flow to the brain during CPR. 2. Effective external mechanical chest compression devices like LUCAS, offer a new tool to aid in the treatment of cardiac arrest victims.

Goran OlivecronaConsulting CardiologistSkåne University Hospital

A New DES with less efficacy but maybe a better saftey profile is on the way.

October 11, 2007

Analysis of:FDA Panel Recommends Approval Of Medtronic Drug-Coated Stent | online.wsj.com

1. ENDEVOR subscribes to cardiologist concerned about the saftey profile of Current DES sold in the US (Cypher and TAXUS). 2. ENDEAVOR seems to carry a higher rate of binary restenosis than Cypher, but may have a lower rate of late stent subacute thrombosis (SAT) than either Taxus or cypher. 3. The impact on J&J and Boston will depend upon what results are seen in the forthcoming results of the ENDEAVOR IV study and also how the issue of Late Stent SAT will develop. 

Goran OlivecronaConsulting CardiologistSkåne University Hospital

Another first generation DES enters the market

January 22, 2007

Analysis of:Boston Scientific Announces First Use Of PROMUS™ Everolimus-Eluting Stent System | www.medcompare.com

1. The PROMUS™ platform is a first generation DES composed of a “limus” drug and a durable polymer placed on cobalt-chromium alloy stent.

2. No large randomized trial data is yet available until presentation of the SPIRIT III data, a 1400 patient randomized trial.

3. PROMUS™ main niche may be better trackability than the other currently available DES on the market. Other than that, use cannot be recommended until after presentation of the SPIRIT III data.

Goran OlivecronaConsulting CardiologistSkåne University Hospital

Is "on label" use of DES the solution ?

December 11, 2006

Analysis of:FDA Stent Panel Agrees that Benefits of On-Label Use Outweigh Risk | www.medpagetoday.com

1. DES do cause a small increase in death and MI

2. The risk does not level off in comparison to BMS

3. DES should be used "on-label"

Goran OlivecronaConsulting CardiologistSkåne University Hospital

Use of current generation Drug eluting stents will decline in markets with high penetration

October 16, 2006

Analysis of:Doubt raised on drug-coated heart stents | www.newsone.ca

1. Although Drug Eluting Stents (DES) significantly decrease in-stent restenosis, there seems to be a small increase in deaths among DES treated patients over the long term (>3 years).

2. In markets with a high penetration of DES, like the US with 80-90% of procedures being performed with DES, the use is likely to go down.

3. Markets with a low penetration of DES-use will probably continue to expand.

Goran OlivecronaConsulting CardiologistSkåne University Hospital

"Short term" results indicate Drug eluting stents are safe for use in acute MI

September 18, 2006

Analysis of:NEJM Articles on DES in MI | content.nejm.org

1.  The studies shows that there does not to appear to be any "short term" (<1 year) saftey issues in using drug eluting stents (DES) in the setting of acute MI.

2. The only real result to come out of the study was a significant decrease in target lesion revasularization  (TYPHOON).

3. Long term saftey remains to be analysed but may be ambigous due to to the small size of the trials.

Goran OlivecronaConsulting CardiologistSkåne University Hospital

New onsite coated DES with promising results

September 18, 2006

Analysis of:Randomized trial of a nonpolymer-based rapamycin-eluting stent versus a polymer-based paclitaxel-eluting stent for the reduction of late lumen loss. | www.medscape.com

1. The translumina system used to apply Rapamycin to a porous stent in the lab may be non-inferior to the TAXUS stent in regards to clinical endpoints, in-stent restenosis, and lumen late loss.

2. This may put the use of non-degradable polymers on DES into question. The polymers used on DES have been implicated as a possible source of late SAT.

3. The study is promising but a larger multi-center trial needs to confirm the results on efficacy.

4. In regards to safety, the trial gives a clear indication that when the stents are coated with rapamycin, it is safe for use.

5. The stents have to be coated in the cath lab on demand, which limits a large scale practical use.

 

Goran OlivecronaConsulting CardiologistSkåne University Hospital

Competition starts with a 25% reduction in the price of Clopidogrel

August 18, 2006

Analysis of:Mixed thoughts on how generic clopidogrel might impact patients, providers | www.theheart.org

1. Plavix (Clopidogrel) with sales in the US in excess of 3 billion dollars currently costs $4 dollars a day. Apotex generic clopidogrel is reported to start selling at $3 a day. For health providers this should be a big boon.

2. For patients currently taking Plavix and paying retail price themselves, it is a welcome reduction in price although a further decrease in price is desired.

3. For upper income patients with insurance covering Plavix the only benefit will be to the insurance company. However for patients who pay for plavix themselves, a reduction in price will benefit them and possibly increase patient compliance to taking clopidogrel

4. BMS will most likely reduce price of plavix to meet the competition from Apotex's generic Clopidogrel as long as it is above $2 a day.

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