[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.