Amjad Hina, Ullah Asad, Shakoor Mehtab, Tanveer Faiqa, Qureshi Mehak, Jahan Fazeelat, Manzoor Hamna, Mahmoud Mohamed H, Masharifa Ahamed Fathima, Halder Anik, Dilawar Rimsha, Anthony Nouman
Internal Medicine, Nazir Bhatti Memorial Hospital, Abbottabad, PAK.
Cardiology, Belfast Health and Social Care Trust, Belfast, GBR.
Cureus. 2025 Jun 23;17(6):e86617. doi: 10.7759/cureus.86617. eCollection 2025 Jun.
Coronary artery disease (CAD) is a major global cause of morbidity and mortality, driving ongoing improvements in percutaneous coronary intervention (PCI). Drug-eluting stents (DES) have largely replaced bare-metal stents (BMS) due to superior performance in reducing restenosis and the need for repeat revascularization. This systematic review compares the efficacy and long-term safety of DES versus BMS in patients undergoing PCI. A total of 13 studies, including randomized controlled trials and observational studies, were included, covering diverse populations and follow-up periods ranging from 1 to 14 years. Primary outcomes assessed were all-cause mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), and target lesion revascularization (TLR). DES, particularly second-generation devices, were consistently associated with lower rates of MACE, MI, and TLR compared to BMS. Everolimus-eluting stents (EES) showed the most favorable safety profile regarding stent thrombosis. Secondary outcomes included in-stent restenosis (ISR) and bleeding risks. Notably, the benefits of DES were more pronounced in patients with diabetes and complex coronary anatomy. Some studies suggested gender-based differences favoring DES in women, though subgroup findings were exploratory and not always powered for statistical comparison. A few long-term studies observed a narrowing of the efficacy gap between DES and BMS beyond 10 years, though the clinical relevance of this remains limited. Overall, the findings support the continued use of DES as the preferred option in most PCI settings, with individualized decisions based on lesion complexity, comorbidities, and patient adherence to dual antiplatelet therapy. Continued innovation in stent design and long-term patient monitoring remains essential to optimizing CAD outcomes.
冠状动脉疾病（CAD）是全球发病和死亡的主要原因，推动了经皮冠状动脉介入治疗（PCI）的不断改进。由于在减少再狭窄和重复血运重建需求方面表现更优，药物洗脱支架（DES）已在很大程度上取代了裸金属支架（BMS）。本系统评价比较了DES与BMS在接受PCI患者中的疗效和长期安全性。共纳入13项研究，包括随机对照试验和观察性研究，涵盖了不同人群，随访期从1年至14年不等。评估的主要结局为全因死亡率、主要不良心血管事件（MACE）、心肌梗死（MI）和靶病变血运重建（TLR）。与BMS相比，DES，尤其是第二代产品，一直与较低的MACE、MI和TLR发生率相关。依维莫司洗脱支架（EES）在支架血栓形成方面显示出最有利的安全性。次要结局包括支架内再狭窄（ISR）和出血风险。值得注意的是，DES的益处在糖尿病和冠状动脉解剖结构复杂的患者中更为明显。一些研究表明存在基于性别的差异，女性更倾向于使用DES，尽管亚组研究结果具有探索性，且并非总能进行有统计学意义的比较。一些长期研究观察到10年后DES与BMS之间的疗效差距缩小，但其临床相关性仍然有限。总体而言，研究结果支持在大多数PCI情况下继续将DES作为首选方案，并根据病变复杂性、合并症和患者对双联抗血小板治疗的依从性做出个体化决策。支架设计的持续创新和患者长期监测对于优化CAD治疗结果仍然至关重要。
