Are drug-eluting stents safe and effective in the long term?

The introduction of drug-eluting stents in 2002 revolutionized interventional cardiology by minimizing restenosis. Reports of increased late stent thrombosis with these stents compared with bare metal stents, probably due to delayed endothelialization, emerged late in 2006. These studies contained serious methodological flaws, however. Subsequent meta-analyses clearly showed only a small incremental risk of late stent thrombosis across all patient groups. Importantly, a significant and sustained benefit of drug-eluting stents due to reduced restenosis and thus repeat revascularization was also shown. Several 'real-world' registries have confirmed these results and suggested that the use of these stents in more complex situations is not associated with adverse outcomes. Stent thrombosis is a multifactorial problem, in which the stent is only one element. Further research is required to determine optimal procedural technique and antiplatelet regimens. Drug-eluting stents are safe and effective in the long-term, though intensive research continues into ways to reduce the risk of stent thrombosis in the next generation.