Safety and Efficacy Update on First-Generation Drug-Eluting Stents

Accumulating data on the safety and efficacy of first-generation drug-eluting stents (DES) show a favorable risk/benefit profile compared with bare-metal stents (BMS). A recently reported collaborative network meta-analysis including >18,000 patients in 38 randomized trials along with other recent meta-analyses indicate that the use of DES versus BMS is associated with a 50%–70% reduction in the need for repeat revascularization and no difference in the rates of overall stent thrombosis, overall mortality, cardiac mortality, or death or myocardial infarction over 4 years of follow-up. Furthermore, the most recent data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) indicate no difference in mortality between DES and BMS use. The collaborative network meta-analysis and other analyses suggest that late stent thrombosis is a distinct but infrequent phenomenon complicating the use of DES; the risk posed by late thrombosis appears to be offset by a reduced need for repeat revascularizations and thus, a reduced risk of adverse outcomes associated with such interventions.