Drug-eluting stents: a review of current evidence on clinical effectiveness and late complications.
Drug-eluting stent (DES) use has increased greatly as a result of early trial evidence of a reduction in restenosis. However, thet are expensive and do not improve patient survival. Therefore their use has been rationed in some countries. There is a paucity of clinical evidence for some patient groups such as non-ST elevation myocardial infarction and multi-vessel disease. Recent studies suggest that the early benefits of drug-eluting stents may be offset by an increased risk in late stent thrombosis which is a potentially fatal complication. However, the absolute risk appears low and, as yet, there is no evidence of an increased risk of stent-thrombosis related myocardial infarction or death in patients studied in randomised clinical trials. Long-term use of anti-platelet therapy may protect against the risk of late stent thrombosis but the optimal treatment strategy is currently unclear. The aim of this paper is to provide an up-to-date review of the current evidence on DES; including clinical effectiveness, the limitations of existing trials, the emerging evidence on late stent thrombosis and the potential role of clopidogrel.
Austin
D
D
Department of Public Health and Health Policy, University of Glasgow, Glasgow, UK.
Pell
J P
JP
Oldroyd
K G
KG
D006083:Graft Occlusion, Vascular / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D017202:Myocardial Ischemia / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage*
D007166:Immunosuppressive Agents; D010975:Platelet Aggregation Inhibitors; D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus