[Is systematic use of drug-eluting stents justified? Arguments against]

Antiproliferative drug-eluting stents represent a miles tone in advances in interventional cardiology. The amount and quality of the scientific evidence now show these new stents to be highly effective in reducing neointimal proliferation, and hence the process of restenosis. Their clinical impact can be expected to become relevant in terms of both increased indications for angioplasty and the extent of stent usage. However, at this time the systematic use of drug-eluting stents for all patients is not considered justified, because of their limited availability, gaps in our knowledge of their safety, and because their unquestioned clinical benefits have been magnified by exaggerated reports of the clinical problem restenosis represents. Currently, the cost of these stents remains high, and the cost/benefit ratio for certain patients is unfavorable. For these reasons selective use of these new stents is considered more reasonable: they should be used only for those patients who will obtain, in absolute terms, the greatest clinical benefit.