Introduction: Drug-eluting stents (DES) are used for percutaneous coronary intervention to overcome problems with bare metal stents (BMS).
DES contain mitotic or anti-inflammatory drugs, which prevent re-stenosis and reduce the rate of revascularisation. However, they have been shown to cause late in-stent thrombosis.
Aim: Aim is to review the most recent evidence comparing DES with BMS in terms of efficacy and safety.
Method: Pubmed and Scopus were searched for relevant articles. Seven articles were found, reviewed and analysed.
Discussion: DES did not improve mortality compared with BMS but they reduced the rate of revascularization. Second generation DES showed more of a benefit than BMS. DES showed more benefit in women and in larger coronary arteries.
DES has shown an increased risk of late stent thrombosis compared with BMS and a possible increase in cardiac deaths. Second generation DES seem to be safer.
Conclusion: DES do not show a significant reduction in rates of MIs or cardiac deaths in comparison with BMS, but do show a reduction in revascularization rates.
While there are safety concerns with first generation DES, second generation DES seem to be safe. It does not seem that DES can replace BMS yet, but newer generations of DES have potential.
Toklu, B. and S. Bangalore, Choosing the Right Coronary Stent in the Modern Era. Current Cardiology Reports, 2014. 16(4): p. 1-10.
Hill, R.A., et al., Drug-eluting stents: a systematic review and economic evaluation. Health Technology Assessment, 2007. 11(46): p. iii.
Htay, T. and M.W. Liu, Drug-eluting stent: a review and update. Vascular health and risk management, 2005. 1(4): p. 263-276.
Palmerini, T., et al., Stent thrombosis with drug-eluting stents: Is the paradigm shifting? Journal of the American College of Cardiology, 2013. 62(21): p. 1915-1921.
Simard, T., et al., The evolution of coronary stents: a brief review. The Canadian Journal Of Cardiology, 2014. 30(1): p. 35-45.
NICE, TA152 Coronary artery disease - drug-eluting stents: guidance. National Institute of Clinical Excellence Technology appraisal guidance, 2008(152).
NICE, Guidance on the use of coronary artery stents. National Institute of Clinical Excellence Technology Appraisal Guidance 2003. 71.
Kandzari, D.E., et al., Final 5-year outcomes from the endeavor zotarolimus-eluting stent clinical trial program: Comparison of safety and efficacy with first-generation drug-eluting and bare-metal stents. JACC: Cardiovascular Interventions, 2013. 6(5): p. 504-512.
Hansen, K.W., et al., Improved two-year outcomes after drug-eluting versus bare-metal stent implantation in women and men with large coronary arteries: Importance of vessel size. International Journal of Cardiology, 2013. 169(1): p. 29-34.
Gordon, P.C., et al., In-hospital and one year outcomes with drug-eluting versus bare metal stents in large native coronary arteries: A report from the evaluation of drug-eluting stents and ischemic events registry. Catheterization and Cardiovascular Interventions, 2013. 82(4): p. E356-E364.
Hsieh, M.J., et al., Long-term outcomes of drug-eluting stents versus bare-metal stents in large coronary arteries. International Journal of Cardiology, 2013. 168(4): p. 3785-3790.
Suzuki, S., et al., Long-term outcome of drug-eluting vs. bare-metal stents in patients with acute myocardial infarction. Subgroup analysis of the nagoya acute myocardial infarction study (NAMIS). Circulation Journal: Official Journal Of The Japanese Circulation Society, 2013. 77(8): p. 2024-2031.
Holmvang, L., et al., Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-segment elevation myocardial infarction: 5 years follow-up from the randomized DEDICATION trial (Drug Elution and Distal Protection in Acute Myocardial Infarction). JACC. Cardiovascular Interventions, 2013. 6(6): p. 548-553.
Greenhalgh, J., et al., Drug-eluting stents versus bare metal stents for angina or acute coronary syndromes. Cochrane Database Of Systematic Reviews, 2010(5).
Elezi, S., et al., Vessel size and long-term outcome after coronary stent placement. Circulation, 1998. 98(18): p. 1875-1880.
Tada, T., et al., Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: Results from a registry of 18,334 patients. JACC: Cardiovascular Interventions, 2013. 6(12): p. 1267-1274.
Bangalore, S., et al., Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: Mixed treatment comparison meta-analysis. BMJ (Online), 2013. 347.
Most read articles by the same author(s)
- Mark Aziz, Review of the Latest Evidence for Use of Low Intensity Pulsated Ultrasound (LIPUS) for Fracture Healing , RA Journal Of Applied Research: Vol 5 No 03 (2019): VOLUME 05 ISSUE 03