[Benefits and risks of drug-eluting stents].
The March 8, 2007-issue of the New England Journal of Medicine contained 5 original articles, 2 commentaries and 1 editorial on drug-eluting coronary stents versus bare metal stents. Over the past 5 years, multiple randomised, controlled trials have shown that drug-eluting stents reduce recurrent stenosis and the need for additional revascularisation procedures. Drug-eluting stents are now used in a large proportion of percutaneous coronary interventions. Following publications reporting a risk of late thrombosis with sudden occlusion, the promises and uncertainties regarding the benefits and risks are now heavily debated. It can be concluded that these first-generation drug-eluting stents, provided that they are used for indications in accordance with the randomised trials, result in a clear reduction in the need for additional revascularisation procedures without an effect on long-term case fatality and myocardial infarction. There is a small but serious risk of sudden thrombosis and occlusion. The task for the future will be to develop stents that do reduce recurrent stenosis but allow a normal endothelisation of the treated coronary artery segment. When drug-eluting stents have reached that stage, they will be clearly advantageous.
Zijlstra
F
F
Universitair Medisch Centrum Groningen, afd. Thoraxcentrum, Postbus 30.001, 9700 RB Groningen.
D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000628:therapy*; D003362:Cost-Benefit Analysis; D016503:Drug Delivery Systems; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects* / Q000191:economics*; D016896:Treatment Outcome