Can the restenosis benefit of drug-eluting and bare-metal stents be predicted?

摘要

Drug-eluting stents (DES) reduce restenosis rates and improve outcomes for patients with coronary artery disease treated with percutaneous coronary intervention (PCI) [1-3]. Concerns have been raised over the higher risk of stent thrombosis (ST), especially with the first-generation DES [4-6]. The restricted duration of dual antiplatelet therapy (DAT; less than 6 months) in early trials has been associated with the reported increased risk of death [7]. This forced physicians to prolong DAT for at least 12 months. Data from registries and meta-analyses have indicated that there is no difference in the risk of early (<30 days) and late (>30 days, <365 days) ST between DES and bare-metal stents (BMS), but an excessive risk emerges after 1 year of follow-up (very late ST) [3,6,8,9]. DAT with clopidogrel and aspirin substantially reduces the risk of ST.