Assessing the Landscape of Stent Thrombosis: The Drug-Eluting Versus Bare-Metal Stent Controversy

Within labeled indications, drug-eluting stents (DES) are as safe as bare-metal stents (BMS). Data from key randomized, controlled trials comparing paclitaxel-eluting stents with BMS or sirolimus-eluting stents with BMS show no difference in risk of death/myocardial infarction or stent thrombosis using uniform definitions of stent thrombosis. However, these trials and other analyses indicate a difference in time distribution of stent thrombosis, with more cases of stent thrombosis occurring later (ie, after 1 year) in patients with DES—a problem to which the lack of adequate antiplatelet therapy appears to be a main contributor. A consistent finding from randomized, controlled trials of DES versus BMS is the significantly reduced need for reintervention associated with DES use. In the absence of any other differences in safety between DES and BMS, this reduced need for reintervention constitutes a significant advantage for DES in clinical practice.