This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mauri, L. Articles by Normand, S.-L. T. Search for Related Content PubMed PubMed Citation Articles by Mauri, L. Articles by Normand, S.-L. T. Related Collections Health policy and outcome research Restenosis Catheter-based coronary and valvular interventions: other Catheter-based coronary interventions: stents Epidemiology

(Circulation. 2008;117:2047-2050.)
© 2008 American Heart Association, Inc.

Editorial

Studies of Drug-Eluting Stents

To Each His Own?

Laura Mauri, MD, MSc; Sharon-Lise T. Normand, PhD

From the Brigham and Women’s Hospital (L.M.), Harvard Clinical Research Institute (L.M.), Harvard Medical School (L.M., S.-L.T.N.), and Harvard School of Public Health (S.-L.T.N.), Boston, Mass.

Correspondence to Laura Mauri, MD, MSc, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail lmauri1@partners.org

Key Words: Editorials • coronary disease • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
All technology has limitations, some of which are not recognized at the time of introduction. Once adopted, technology may be challenged as to whether the initial promise of patient benefit demonstrated in clinical trials has been achieved in the setting of routine practice. This challenge is the objective of observational studies. Among interventional cardiologists, the jury on drug-eluting stents is still out.

Article p 2071

Progress has not been linear for coronary stenting technology. The introduction of 2 new stents that largely prevented the problem of restenosis^1,2 was met by an explosive adoption of these techniques by physicians and requests by patients. Within the first 8 months of introduction in Massachusetts, the rate of drug-eluting stents (DES) as a proportion of total stent procedures reached 90%.³ However, reports of late adverse events and stent thrombosis, a rare but morbid event, raised alarm in patients and prompted caution from regulators and physicians. The net outcome has been a return to increased use of bare-metal stents, with DES use decreasing to 64% in the United States (Millenium Research Group, Waltham, Mass, written communication, 2007).

The benefits of restenosis prevention observed in randomized trials comparing DES to bare-metal stents were far greater in magnitude than many other incremental changes in medicine. Relative reductions in the need for repeat procedures to treat restenosis reached 75% to 80%,^1,2 a larger jump forward than that achieved with the introduction of bare-metal stents to replace balloon angioplasty.^4,5 Although the composite end points in the pivotal trials of . . . [Full Text of this Article]

This article has been cited by other articles:

				S. B. King III Which stent for diabetic patients: the glass half-full or half-empty? Eur. Heart J., November 27, 2009; (2009) ehp390v1. [Full Text] [PDF]

				L. Mauri, T. S. Silbaugh, R. E. Wolf, K. Zelevinsky, A. Lovett, Z. Zhou, F. S. Resnic, and S.-L. T. Normand Long-Term Clinical Outcomes After Drug-Eluting and Bare-Metal Stenting in Massachusetts Circulation, October 28, 2008; 118(18): 1817 - 1827. [Abstract] [Full Text] [PDF]

				S. B. King III and E. L. Hannan Mounting Evidence for Safety and Improved Outcomes of Drug-Eluting Stenting: But Is It the Stent? Circulation, October 28, 2008; 118(18): 1783 - 1784. [Full Text] [PDF]

				Drug-Eluting Stents: Is the Tide Turning? Journal Watch Cardiology, June 4, 2008; 2008(604): 2 - 2. [Full Text]