KEY POINTS:
Specialists want the Government to pay for more heart patients to have a drug-coated device placed in their arteries, despite international controversy surrounding the small metal "stents".
The Cardiac Society of Australia and New Zealand believes the devices are safe and effective and wants their use increased by up to half.
The meshed metal stents are placed in heart arteries to re-open narrowed arteries. In 2003 and 2004, new stents were approved in the United States which had a drug coating to reduce the problem of tissue growing into the mesh and re-narrowing the artery.
Concern erupted internationally last year over research suggesting a slightly increased rate of potentially fatal blood clots with the drug-coated stents compared with the bare-metal version. Around 80 per cent of stents used in the US are drug-coated.
In New Zealand around 1000 drug-releasing stents are placed a year - 20 to 30 per cent of all stents, but heart specialists want this to increase to 30 to 40 per cent.
At around $3000 each, the drug-releasing stents cost more than three times the bare-metal ones.
The latest New England Journal of Medicine contains a slew of articles on the controversy, with findings for and against drug-releasing stents.
"Our motivation," says a journal editorial, "is the recent concern that the implantation of drug-eluting stents, as compared with bare-metal stents, may be associated with a small increased risk of late stent thrombosis".
Auckland City Hospital cardiologist Professor Harvey White said yesterday: "This has had big media overseas, saying there should be a moratorium on putting these in.
"There have been a handful of deaths in New Zealand of people who had drug-eluting stents. It's very difficult to ascertain whether that is related to their previous heart attack or not."
New Zealand patients given the drug-coated stents tended to have worse heart disease than those in the clinical trials on which the devices were licensed in the US so their outcomes were expected to be worse, Professor White said.
His advice was not to stop anti-clotting medication prematurely, delay non-urgent surgery and ensure a cardiologist was consulted before any surgery.
Cardiac Society spokesman Associate Professor John Elliott, of Christchurch Hospital, said continued use of drug-coated stents in selected patients was justified. As they were used much less in New Zealand, concerns over them were also less than elsewhere.
A spokesman for state drugs buyer Pharmac said it was investigating the possibility of purchasing drug-coated stents on behalf of district health boards.
But, it said, if this happened, it would not be until after July 1.
Heart of Matter
* Stent: a small mesh metal "scaffold" placed in a narrowed heart artery to help re-widen it. Inserted using a tube, usually through a blood vessel from the groin.
* Since 2003, many stents have had a drug coating to reduce re-narrowing.
* Some studies, but not others, have found a higher rate of blood clots with drug-coated stents.
* These clots can cause a fatal heart attack.
