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At AHA, A Debate Over Drug-Eluting Stents

If any medical device should confirm the role of clinical trials in influencing adoption, it's drug-eluting stents. But a debate at the American Heart Association meeting made clear that evidence-based medicine wasn't the ony side of the story. Beyond simple resistance to change, real-world issues--concerns over costs and unforeseen future consequences, among the most notable--often argue more strongly to physicians.

If any medical device should confirm the role of clinical trials in influencing adoption patterns, it's drug-eluting stents (DES). The first two trials, FIM and RAVEL, presented widely at cardiology conferences last year, only underscored the tremendous promise of drug-eluting stents. Indeed, their perfect results—0% restenosis and target vessel revascularization rates—sent shivers through an interventional community that hadn't dared to hope results could be that good. Subsequent trials, most notably SIRIUS, the first large population trial, which premiered at this year's Paris Course on Revascularization and Transcatheter Cardiovascular Therapeutics meetings, and TAXUS, though less than perfect, were nonetheless compelling in arguing for the clinical value of DES.

But resistance to widespread adoption of DES remains stronger than some clinicians and industry executives might have expected, as was...

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