Outcomes following coronary stenting with different drug-eluting and bare-metal stents

This article analyzed data currently available regarding the outcomes using different types of stents to restore circulation through the coronary arteries following a heart attack. Researchers compared the use of bare-metal stents and drug-eluting stents (first and second generation).

Stenting is a procedure done as part of angioplasty – a procedure to dilate the blood vessels leading to the heart (coronary arteries). The procedure is minimally invasive, done with the help of a tiny catheter inserted through an artery in the groin or wrist. Stents are mesh tubes that are placed in the coronary arteries to keep them open after the procedure.

There are several types of stents:

• Bare metal stents (BMS) – these are simple mesh tubes
• Drug eluting stents (DES) – these are mesh tubes that also slowly release a drug that prevents blockage of the stent.

First generation DES include sirolimus and paclitaxel eluting stents. Second generation (newer) DES include everolimus eluting stents.

Researchers studied the published medical literature and identified 12 453 patients who had had stents inserted after a heart attack. They compared the outcomes of this procedure when using the different types of stents available.

Results from the study showed that up to 1 year following the procedure, sirolimus eluting stents were most effective at preventing re-blockage of the coronary arteries. However, long-term follow up (over 1 year) suggested that the second generation, everolimus eluting stents, were better than both BMS and first generation DES. There was a significantly lower risk of re-blockage of the stent and complications (such as heart attack). First generation DES were found to be more effective than BMS.

In conclusion, the article supports the idea that everolimus eluting stents (second generation) are better than the other types of stents available (BMS and first generation DES). First generation DES were also found to be better than BMS.

These results are not derived from a single large trial, but rather a combination of several studies, which followed different research methods.

Angioplasty options should be thoroughly discussed with the treating physician in order to choose the best stents available.