Interpreting the music of drug-eluting stents: halcyon song or albatross dirge?

摘要

When drug-eluting stents (DES) were introduced clinically in 2003 as the long-sought cure for restenosis, the Center for Medicare and Medicaid Services (CMS) was so persuaded that these devices were a breakthrough technology that it took the almost unprecedented step of increasing reimbursement to account for their substantially greater cost. Debating the appropriate use of this technology, interventional cardiologists in the U.S. worried that they might be judged guilty of medical malpractice if they failed to provide DES wherever possible in patients undergoing percutaneous intervention (PCI). Within a few years, DES were being routinely used in over 80% of all PCIs across the U.S. and in several European countries..