Key result
First-generation DES reduces target lesion revascularization by ~60% vs bare metal stents.
Why the study?
Drug-eluting stents reduce restenosis but concerns about very late stent thrombosis and long-term safety remain.
Do first-generation drug-eluting stents reduce target lesion revascularization compared with bare metal stents?
Do first-generation drug-eluting stents reduce target lesion revascularization compared with bare metal stents?
First-generation drug-eluting stents significantly reduce target lesion revascularization compared to bare metal stents, though they are associated with a distinct risk of very late stent thrombosis.
Supports first-generation DES for fewer revascularizations; leaves open very late thrombosis risks versus contemporary stents.
D rug-eluting stents (DES) represent a breakthrough tech-nology owing to their potent reduction of restenosis, which is a nuisance in the quality of life of affected patients, a rare cause of myocardial infarction (MI), and the principal shortcoming of stents compared with coronary artery bypass surgery.First-generation DES with controlled release of sirolimus or paclitaxel from durable polymers reduce the need of target lesion revascularization by 50 to 70% compared with bare metal stents, requiring treatment of only 8 patients (number needed to treat 6 to 10) to prevent 1 revascularization event. 1 The benefit, albeit attenuated, persists in studies without protocol-mandated angiographic follow-up, 2 is particularly pronounced in diabetic patients, 3 and endures during long-term follow-up extending to 5 years. 1 The safety of first-generation DES has been scrutinized in unprecedented depth and comprehensiveness after insinuation of impaired clinical outcome.Even though mortality and MI were found to be similar or even lower with the use of first-generation DES in randomized trials, meta-analyses, and large-scale registries, 4 very late stent thrombosis (ie, sudden thrombotic occlusion of the device Ͼ1 year after implantation) emerged as a distinct entity complicating their use.
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Windecker et al. (2009) conducted a review in Restenosis. First-generation drug-eluting stents vs. Bare metal stents was evaluated on Target lesion revascularization (50 to 70% reduction, 95% CI 6-10). First-generation drug-eluting stents reduce the need for target lesion revascularization by 50 to 70% compared with bare metal stents, with a number needed to treat of 8.
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