Limited evidence for effectiveness of drug-eluting coronary artery stents

January 01, 0001

Limited evidence for effectiveness of drug-eluting coronary artery stents

Clinical Question: How effective are drug-eluting stents compared with bare metal stents in the reduction of cardiac events (angina or acute coronary syndrome)?

Bottom line: Drug-eluting stents are effective in reducing rates of restenosis but are not superior to standard bare metal stents in terms of decreasing deaths, myocardial infarction or thrombosis. Drug-eluting stents evaluated contained sirolimus, paclitaxel, dexamethasone, zotarolimus, everolimus and tacrolimus.

Caveat: The review was unable to report outcomes uniformly across all-time points and for all outcomes for all drugs. Long-term efficacy and safety data have not yet been confirmed as few trials reported outcomes beyond one or two years.

Context: Coronary artery stents are small, tubular devices used to ÒscaffoldÓ vessels open during percutaneous transluminal coronary angioplasty. Restenosis of vessels treated with stents is a problem; in order to reduce restenosis, stents that elute drugs over time have been developed. However, there is a need to assess their clinical benefit prior to recommending their use. The increased cost of drug-eluting stents and current lack of evidence of their cost-effectiveness means that various health funding agencies are limiting or regulating their use.

Cochrane Systematic Review: Greenhalgh J et al. Drug-eluting stents versus bare metal stents for angina or acute coronary syndromes. Cochrane Reviews 2010, Issue 3. Article No. CD004587. DOI: 10.1002/14651858. CD004587.pub2. This review contains 47 studies involving 14,500 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 273, July 2010. .
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: K. Circulatory. Keywords: coronary artery disease, drug-eluting stents, restenosis, thrombosis
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 16 November 2010

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.