[Drug-eluting or bare-metal stents in interventional cardiology. Theory and practice]

Area of Science:

• Interventional Cardiology
• Biomedical Engineering
• Cardiovascular Research

Context:

• Drug-eluting stents (DES) represent a significant advancement in treating coronary artery disease.
• Following coronary angioplasty and bare-metal stent implantation, DES emerged as the third major milestone.
• Despite widespread adoption, robust clinical evidence supporting DES benefits remains limited.

Purpose:

• To critically evaluate the clinical efficacy and safety of drug-eluting stents (DES).
• To address the discrepancy between the perceived benefits and the lack of conclusive data on hard endpoints for DES.
• To define precise indications and limitations for DES use to prevent their potential avoidance.

Summary:

• DES have demonstrably reduced restenosis rates in coronary interventions.
• However, studies utilizing hard clinical endpoints have not consistently shown a mortality benefit.
• Recent meta-analyses raise concerns, suggesting a potential increase in mortality associated with DES implantation.

Impact:

• Highlights the need for further research to clarify the long-term outcomes of DES.
• Emphasizes the importance of establishing clear clinical guidelines for optimal patient selection and use of DES.
• Informs clinical practice and future development of cardiovascular interventional devices.