Roderick Tung, MD; Sanjay Kaul, MD; George A. Diamond, MD; Prediman K. Shah, MD
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Sanjay Kaul, MD, Division of Cardiology, Room 5536, South Tower, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048.
Current Author Addresses: Drs. Tung, Kaul, Diamond, and Shah: Division of Cardiology, Room 5536, South Tower, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048.
Tung R, Kaul S, Diamond GA, Shah PK. Narrative Review: Drug-Eluting Stents for the Management of Restenosis: A Critical Appraisal of the Evidence. Ann Intern Med. 2006;144:913-919. doi: 10.7326/0003-4819-144-12-200606200-00009
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Published: Ann Intern Med. 2006;144(12):913-919.
Interventional cardiologists have quickly replaced bare metal stents with intravascular drug-eluting stents for treating and preventing restenosis, largely on the basis of empirical evidence that shows profound reduction in angiographic and clinical restenosis. A critical reassessment of the published evidence, however, suggests that the putative superiority of intravascular drug-eluting stents is founded on questionable premises, including 1) overestimation of restenosis benefit, 2) underestimation of the risk for stent thrombosis, 3) overreliance on â€œsoftâ€ rather than â€œhardâ€ outcomes (need for repeated revascularization vs. death or myocardial infarction), and 4) the attendant overestimation of cost-effectiveness. Because the long-term incremental risks, benefits, and costs of drug-eluting stents have not yet been optimally evaluated in a broad spectrum of patient and lesion cohorts, the rational role of these devices in clinical management warrants reappraisal.
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Cardiology, Emergency Medicine, Acute Coronary Syndromes, Coronary Heart Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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