Early experiences and clinical implications of restenosis and drug-eluting stents: Part 2.

OBJECTIVE

To review early clinical experience and future implications of drug-eluting stents (DES) in percutaneous coronary interventions.

DATA SOURCES

Using the search terms sirolimus, paclitaxel, and drug-eluting stents, a literature review was conducted to identify peer-reviewed articles and abstracts in MEDLINE (1966-June 2003). Recent meeting abstracts were also accessed through the American Heart Association and the American College of Cardiology Web sites. Citations from available articles were reviewed for additional references.

STUDY SELECTION AND DATA EXTRACTION

Published reviews and studies showing the effects of in-stent restenosis and drug-coated and -eluting stents were evaluated and reviewed.

DATA SYNTHESIS

Current antiplatelet and antithrombotic therapy have proven successful in preventing acute in-stent thrombosis, but not in-stent restenosis. Recently, stents eluted with certain antimitotic agents have demonstrated positive findings in reducing restenosis (eg, sirolimus, paclitaxel-eluting stents) compared with bare-metal stents. However, data regarding long-term benefits and adverse effects are only beginning to accumulate.

CONCLUSIONS

While the current clinical efficacy and safety of DES appear promising, further investigations are required to examine long-term efficacy, safety, and cost-effectiveness. Subanalysis of the current data may help to determine the specific patient population that may benefit maximally from DES.