An evidence-based approach to the use of drug-eluting stents in clinical practice.
Less than a year after their release, drug-eluting stents are being used in more than 70% of patients who undergo percutaneous intervention for obstructive coronary disease in the United States. This unprecedented quick adoption was fueled by results of several randomized trials that demonstrated a profound reduction in restenosis rates compared with bare-metal stents. Subset analysis of the drug-eluting stent trials shows a strong restenosis reduction rate across a wide range of patient characteristics; however, these broad beneficial effects are based on randomized subjects who may not represent the actual population currently being treated with coronary stents. This review presents an analysis of the available data on the approved drug-eluting stents, including patient subsets that may or may not benefit; potential stent-specific complications; and a discussion of costs, risks, and cost-effectiveness.
Kuntz
Richard E
RE
Division of Clinical Biometrics, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02115, USA. rkuntz@partners.org
Wang
John C
JC
Mauri
Laura
L
Cohen
David J
DJ
D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D004059:Diffusion of Innovation; D016503:Drug Delivery Systems; D019317:Evidence-Based Medicine; D006801:Humans; D017239:Paclitaxel / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D040242:Risk Reduction Behavior; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015607:Stents
D017239:Paclitaxel; D020123:Sirolimus