Trends in PCI - PCI vs. Thrombolysis: The Debate

SUMMARY

Introduction

• Drug-eluting stents have become the gold standard in PCI procedures; it isup for debate as to whether biodegradable stents become the future goldstandard. The debate about PCI vs thrombolysis still continues, howeveropinion seems to be falling firmly on the side of PCI.

Scope of this report

• Market overview and review of the rise of drug eluting stents togold-standard status, with an update on clinical trials and reimbursementstatus
• Identify the key players in the PCI drug-eluting stent market andunderstand how this is likely to change with the advent of biodegradablestents
• Follow the debate on PCI vs. thrombolysis and understand why opinionleaders seem to favor PCI
• Understand the critical issue around time-to-needle and remote transfer

Research and analysis highlights

• The drug-eluting stent seems to be the device for the future by solving(and promising to solve) one of the largest problems of interventionalcoronary treatment: restenosis. Opinion leaders interviewed by Datamonitorin 2004 suggest that the use of drug-eluting stents has reached 9095% of thestent market both in the US and Europe.
• It is now thought that even with the additional delay, transfer ofpatients for PCI is associated with better outcomes than treating withthrombolysis at the local hospital.
• When primary PCI cannot be provided readily and transfer is necessary,intravenous thrombolysis may be a better choice for patients seen early(within the first two hours), especially if it can be provided in apre-hospital setting. This does not preclude subsequent transfer to aninterventional center.

Key reasons to read this report

• Understand the reasons for the success of drug-eluting stents and theirrise to becoming the gold-standard treatment
• Identify the key players in the PCI drug-eluting stent market andunderstand how the market will evolve with the advent of biodegradablestents
• Understand why opinion leaders seem to favor PCI over thrombolysis and thecritical issue around time-to-needle and remote transfer

TABLE OF CONTENTS

ABOUT DATAMONITOR HEALTHCARE

• About the Cardiovascular pharmaceutical analysis team

EXECUTIVE SUMMARY

• Introduction
• Scope and coverage of this Brief
• Key findings about the topic

PERCUTANEOUS CORONARY INTERVENTION MARKET DYNAMICS

• The PCI market
• Evolution to drug-eluting stents
• Success of the drug-eluting stent
• Cost effectiveness of drug-eluting stents
• The drug-eluting stent gold standard
  • Cypher
  • Taxus
• Latest clinical trial update
  • Taxus
  • Cypher
• Safety and side-effect issues with drug-eluting stents
  • Stents and the use of adjunctive therapy
• Reimbursement update
  • UK
  • France
  • Belgium
• New entrants
  • Biodegradable stent technology
• Future market

PCI VS. THROMBOLYSIS

• PCI is the way forward
• Time-to-needle
• Remoteness and transfer time
• Pre-hospital thrombolysis: the next step?
• New developments
• Conclusion

APPENDIX

• Contributing experts
• Bibliography
  • Other Clinical Data
  • Research methodology
  • Disclaimer
• List of Tables
  • Table 1: Comparison of cost of bare-metal and drug-eluting stents
  • Table 2: Drug-eluting stents marketed or in development
  • Table 3: Price comparisons of adjunctive therapies
• List of Figures
  • Figure 1: Advances in PCI have improved patient outcomes (US data)
  • Figure 2: Drug-eluting stents have further improved patient outcomes
  • Figure 3: Breakdown of treatment time and mortality rate