Roderick Tung, MD; Sanjay Kaul, MD; George A. Diamond, MD; Prediman K. Shah, MD
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.
Learn more about subscription options.
Register Now for a free account.
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
Download citation file:
Published: Ann Intern Med. 2006;144(12):913-919.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only