title: Are drug-eluting stents superior to bare metal stents when compared to coronary artery bypass surgery? Show me the data.
abstract: Recent randomized trials comparing coronary artery bypass surgery (CABG) versus drug eluting stents (DES) observed better survival, survival free of myocardial infarction (MI) and free from death, MI and stroke in patients with 3-vessel disease and diabetics if they were treated with DES. In the past, when we used bare metal stent (BMS) and meta-analysis of randomized trials with BMS and CABG, patients with 3-vessel disease and those with diabetes at 5 years of follow up had similar incidence of death, MI and stroke with CABG and BMS. The results reported recently by the SYNTAX and FREEDOM trials suggested a lack of clinical benefit with DES compared to BMS. The author in the article compared these recent results with the above meta-analysis and made an indirect comparison among DES, BMS and CABG. Reasons for these intriguing findings were discussed, and also a search for potential solutions was conducted.
authors.affiliation: Cardiac Unit, Otamendi Hospital, Buenos Aires, Argentina. arodriguez@centroceci.com.ar
authors.forename: Alfredo E
authors.initials: AE
authors.lastname: Rodriguez
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D006801:Humans; D008670:Metals; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals