Head‐to‐Head and Extrapolated Comparisons of Different Drug‐Eluting Stents: Differences in Late Loss, Restenosis, and Clinical Outcomes

Drug‐eluting stents (DES) have been appraised as breakthrough technology owing to their potent reduction of restenosis, an important nuisance in the quality of life of affected patients, the rare cause of myocardial infarction, and the principal shortcoming compared with coronary artery bypass surgery. First‐generation DES with controlled release of sirolimus or paclitaxel from durable polymers have been attested to reduce the need of target lesion revascularization by 40% to 70% compared with bare metal stents (BMS) requiring treatment of only eight patients (number needed to treat [NNT] 6–10) in order to prevent one revascularization event. The benefit, albeit attenuated, persisted in studies without protocol‐mandated angiographic follow‐up, was particularly pronounced in diabetic patients, and endured during long‐term follow‐up extending to 5 years. While the therapeutic benefit of first‐generation DES has primarily been established as compared against BMS, more recent investigations have concentrated on direct head‐to‐head comparisons between various DES. To date, a number of newer‐generation DES are already in clinical use or under investigation with newly designed stent platforms, improved polymer coatings, and a variety of different drugs. This review will address differences between various DES platforms in terms of angiographic and clinical outcomes. Moreover, the differential outcome of DES in several important patient subgroups will be analyzed.