An update on drug-eluting stents

Opinion Statement: Coronary artery disease remains one of the major causes of morbidity and mortality worldwide. Percutaneous coronary intervention has been shown to be an effective treatment for angina pectoris, although it does not provide any prognostic benefit in stable patients. Drug-eluting stents (DES) have revolutionised the practice of interventional cardiology by permitting the percutaneous treatment of increasingly complex coronary artery lesions, which historically would have only been treated with surgery. There have been concerns with their long-term safety; however, the most recent large meta-analysis appears to suggest that these concerns are no longer a pertinent issue with the newest generation of stents. Consequently, DES are being used in complex patients and lesion types, and clinical data and guideline recommendations support this. New stent designs are also continually being developed, with the aim to further improve the safety profile of these devices. It must, however, be kept in mind that complacency following the impressive result from initial DES studies lead to, amongst others things, sub-optimal and careless stent deployment, and inappropriate patient selection, which may have ultimately contributed to the prior safety concerns. It is vital, therefore, that this is not repeated in light of the reassuring data, or with newer devices. Finally, as stent design improves, it is becoming increasingly difficult to identify meaningful and clinically relevant differences in stent performance without the requirement of a very large, expensive, randomised trial.

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