From randomized trials to routine clinical practice: an evidence-based approach for the use of drug-eluting stents.
The availability of drug-eluting stents has resulted in a paradigm shift in the management of patients with coronary artery disease with a substantial increase in the percentage of patients being revascularized percutaneously rather than surgically. Since its introduction, there has been a tremendous increase in the use of drug-eluting stents with nearly 90% of patients in the US who undergo percutaneous interventions receiving drug-eluting stents. The promising results of several randomized trials that demonstrated a profound reduction in restenosis rates compared with bare-metal stents, underscores the unprecedented enthusiasm among the cardiology community to adopt this new technology swiftly. Data regarding the safety and superiority of drug-eluting stents abound, and it is imperative for the practicing clinician to review and apply them in appropriate clinical settings. In this review, we present general concepts of drug-eluting stents, and attempt to summarize the available data on the approved drug-eluting stents in a variety of patient and lesion subsets. In addition, we share some insights regarding the potential limitations, and issues specific to drug-eluting stents.
Thanigaraj
Srihari
S
Cardiovascular Division, Washington University School of Medicine, St Louis, Missouri 63110, USA. harit@im.wustl.edu
Wollmuth
Jason R
JR
Zajarias
Alan
A
Chemmalakuzhy
Jacob
J
Lasala
John M
JM
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible