Drug-Eluting Stents' Benefits Appear to Outweigh Risks
Comparing risks of late thrombosis with bare-metal stents difficult due to rarity of event, lack of data
TUESDAY, Dec. 18 (HealthDay News) -- Evidence suggests that the net benefit of drug-eluting stents in relieving obstructive coronary artery disease exceeds the risks of stent thrombosis, according to the authors of a perspective paper published online Dec. 18 in the Annals of Internal Medicine.
Allen Jeremias, M.D., of Stony Brook University Medical Center in Stony Brook, N.Y., and Ajay Kirtane, M.D., of Columbia University Medical Center in New York City, reviewed current clinical data in assessing the rapidly expanding role of drug-eluting stents in coronary artery revascularization.
The rate of stent thrombosis 24 hours to 30 days after stent implantation appears similar between drug-eluting and bare-metal stents. But several studies indicate an increase in late thrombosis (30 days or more after implantation) in drug-eluting stents, with up to 0.5 percent incidence per year. However, the true relative incidence of these events is hard to assess, given their rarity and the scarcity of data available to inform the discussion.
"Numerous studies and registries have demonstrated that when used for 'on-label' indications, drug-eluting stents are effective at reducing restenosis and the need for repeat revascularization in all patient subgroups and lesion types, without an increase in late myocardial infarction or excess mortality. However, there are few overall safety data from adequately controlled trials on the use of drug-eluting stents for 'off-label' indications," the authors write. "All patients should undergo rigorous screening before coronary intervention to assess their ability to tolerate uninterrupted dual antiplatelet therapy for a minimum of three to six months and preferably one year."
Kirtane has consulted for Medtronic Vascular and received honoraria from Boston Scientific.