Boston Scientific, J&J, Wall Street Gird for Bad News (Update3) http://www.bloomberg.com/apps/news?pid=20601109&sid=a_lygbtSgIhQ&refer=home By Michelle Fay Cortez March 23 (Bloomberg) -- Boston Scientific Corp. and Johnson & Johnson may get more bad news about their stent heart devices when results of a large patient study come out next week. Doctors and analysts say they expect the study, to be released at a science meeting March 27, to show that stents used to prop open clogged arteries are no better than drug therapy in preventing deaths and heart attacks for patients with cardiovascular disease. Sales of certain stents have been declining since last year when the devices were linked to an increase in blood clots. The latest study may raise new questions about the benefits of using the tiny mesh tubes that are implanted into the arteries of a million Americans annually. Boston Scientific's shares have fallen 10 percent and J&J shares are down 5.5 percent in the past month on rising investor concerns about the devices. ``Wall Street certainly has the expectation that there will be no difference shown'' between stents and drug therapy, said Thomas Gunderson, an analyst at Piper Jaffray & Co. in Minneapolis. ``Wall Street is worried about the media coverage that may fuel patients' fear that there is really no good reason to have a stent implanted,'' he said. Shares of Natick, Massachusetts-based Boston Scientific fell 47 cents to $15.12 at 1:37 p.m. in New York Stock Exchange composite trading, and New Brunswick, New Jersey-based Johnson & Johnson fell 50 cents to $60.36. Boston Scientific has dropped 12 percent this year, and J&J has fallen 8.6 percent. `Sizzling Hot' Study The latest study, involving 2,287 patients, was carried out to determine whether stents placed in arteries prevent deaths and heart attacks better than aggressive therapy using a combination of drugs to lower cholesterol, reduce blood pressure and prevent clots in patients with heart disease. No previous work has found such a benefit. Heart researchers at Buffalo General Hospital in New York state conducted the study, dubbed Courage. It will be released at the annual meeting of the American College of Cardiology in New Orleans. The study is ``sizzling hot,'' said Steven Nissen, president of the cardiology college and the chairman of cardiology at the Cleveland Clinic. ``It really asks the question, never before asked in the modern era, whether aggressive drug therapy without an angioplasty is as good or not as good as aggressive medical therapy.'' Angioplasty is a procedure in which a small balloon-tipped catheter is threaded into a clogged artery that carries oxygen- rich blood to the heart. Stents are left behind to keep the artery from re-closing. Reducing Chest Pain Doctors know angioplasty and stenting can reduce chest pains caused by blocked arteries. The new study was designed to see whether the procedures prevent deaths and heart attacks, too. Worldwide sales of stents last year came to $5.4 billion. Johnson & Johnson generated $2.62 billion of its total 2006 sales of $53.3 billion, from the product. Boston Scientific garnered $2.36 billion, or 30 percent, of its revenue last year from stents. Officials at both companies say a negative result shouldn't inhibit the use of stents. That's because previous smaller trials already suggested stents and drug use, often called medical therapy, yield similar clinical results for patients with heart disease. The stents used in the study were primarily the older, bare- metal models that aren't coated with medication. The companies and some analysts said use of the older models may have hurt the performance of the stents in the study. Nothing New No trial of artery clearing procedures, with or without a stent, ``has ever shown that it improves the already good survival from medical therapy,'' said Donald Baim, chief medical officer for Boston Scientific, in a March 20 telephone interview. The results of the study aren't applicable to patients with a heart attack or sudden chest pain caused by blocked blood flow to the heart. In those people, studies show restoring flow as quickly as possible with angioplasty and a stent saves lives. Stent sales are falling since European researchers last September tied coated stents to the formation of potentially deadly blood clots months or years after they were inserted. The best defense against clots is blood-thinning drugs that are recommended to patients for a full year after a stent is implanted. Boston Scientific today said it will spend up to $40 million on education and financial aid to encourage patients to follow doctors' orders and take the drugs for the entire year. Drug-Coated Stents A declining percentage of Johnson & Johnson and Boston Scientific sales are going to the more expensive, so-called drug- eluting versions of the stents considered by doctors to be better than bare-metal versions in keeping arteries open. In May 2006, about 88 percent of stents used at U.S. hospitals were drug-coated, according to Goodroe Healthcare Solutions, a consultant on hospital purchasing. Now some hospitals say they are using them about 60 percent to 65 percent of the time. Shortages are arising for bare-metal versions, doctors say. ``Drug-eluting stents are having a tough time,'' Piper Jaffray's Gunderson said. Patients often demand angioplasty, to clear out the clogged artery, with a stent used to keep it propped open, said Samin Sharma, director of interventional cardiology at Mount Sinai Medical Center in New York, in a March 21 telephone interview. When Sharma tells patients that more than half of a critical artery is blocked, they want aggressive treatment to open the artery, he said. ``You tell a patient they have a 70 percent or 80 percent blockage, and they freak out,'' said Sharma, who does 1,500 procedures a year, one of the highest rates in the U.S. ``People are telling them, `You are a walking time bomb.' They want things done now. That's American culture.'' Sharma expects the study will show patients getting stents will have less chest pain, fewer hospitalizations and better ability to exercise. He doesn't think they will live longer.