Better recovery rate, reduced re-intervention
Can you tell us about research into the use of the new type of stents (tubes inserted into the artery) in coronary disease? The impact of drug-eluting stents has been quite dramatic. In our practice, in 90 percent of the times that we need to do a coronary artery dilation, we accompany that by implanting a drug-eluting stent. The advantage is that as you know that it substantially reduces the risk of the re-stenosis (the return of the narrowing) and the patient needing another intervention. So the majority of cases now involve implanting more than one stent in more than one blockage and more than one artery. The only losers are the operating rooms because in every hospital around the world that does cardiac surgery, bypass surgery and stenting, the impact has been to move some patients whom five years ago we would have treated with bypass surgery, to stenting. How much of an impact has this had on the bypass surgery? In the state of Maryland, hospitals have seen a between 10-25 percent reduction in coronary artery bypass surgery. Cardiac surgery is also an evolving field and they have advanced to new things, including the treatment of advanced heart failure. So cardiac surgery is finding new fields. Can you give us figures as to the advantages of the new stent? When I started doing these procedures when we only had the balloon, the rate of needing to do another intervention was as high as 35 percent. The bare metal stents that we first had access to in 1994-5 reduced that significantly but not dramatically – now it’s to 25 percent or so. It made angioplasty safer and modestly more effective. Of course, the individual patients’ risk depends on the size of the blockage, the size of the artery the presence or absence of diabetes and so on. So what does Johns Hopkins have that patients wouldn’t find elsewhere? We have access to technology that allows us to do things many hospitals can not, but I think the real strength in our program is also that we have a team of professionals. I can very easily call an ad hoc conference in the procedure room and have everyone – two cardiac surgeons, three interventional cardiologists, a cholesterol expert, heart failure expert – converge and debate the merits of different treatments for that patient. Probably even more significantly is the ability to translate, because of the expertise of this team, basic research approaches into new therapies. The drug-eluting stent (program) was one where we literally took this from the test tube to small animal research, large animal research and ultimately to humans. Has your government’s position on stem cell research had any impact on limiting what you do? The cells which have ethical and regulatory challenges are embryonic stem cells. Fortunately, it seems that there are many other types of cells which have some indication that they will work. We have very active programs moving forward with two different cell approaches, one from bone marrow and one with cardiac stem cells that under the right conditions can grow into a «cardiac sphere» and begin to beat.
