Efficacy and safety of drug-eluting stents in the treatment of coronary artery disease

ABSTRACT

Strength of Recommendations: Weak in favor of drug-eluting stents

Technology: Drug-eluting stents

Indication: Indicated to increase coronary luminal diameter and reduce stent restenosis of patients with coronary artery disease.

Characterization of the technology: Metal Tubular structures, coated with a polymer and an antiproliferative agent, used to maintain the arterial lumen opened and to prevent restenosis of the lesion and the target vessel by mechanical pressure and local administration of drugs.

Question: Drug-eluting stents (DES) are safer and more effective than bare metal stents (BMS)? There are differences between the various drug-eluting stents?

Search and analysis of scientific evidence: We searched the Medline and EMBASE and included systematic reviews (SR) of randomized controlled trials (RCTs) comparing DES with each other or compared to BMS for treatment of patients with coronary artery disease.

Summary of results of selected studies: 29 SR were selected and half of them had moderate to high quality. The strength of recommendation was weak for most studies. The use of DES was associated with a significant reduction of reintervention and major adverse cardiac events (combination of acute myocardial infarction, target lesion restenosis or need for reintervention or intra-stent thrombosis) compared to BMS. There was no difference in the risk of mortality, myocardial infarction and intra-stent thrombosis. After one year of follow-up, DES were associated with a higher risk of late and definitive thrombosis. Among DES, sirolimus and everolimus showed better results. The efficacy and safety profile for the subgroup of diabetic patients was similar to that observed for other patients.

Recommendations: There was consistency between studies regarding the efficacy of DES compared to BMS, as assessed by the reduction of the reintervention rate. However, in robust outcomes such as death and myocardial infarction there was no difference between the various technologies compared. Considering the quality of the evidence, the results and the high cost of drug-eluting stents in Brazil, we recommend weakly the use of eluting stents for patients with coronary artery disease who have complex anatomy of the lesion and at high risk of reintervention, such as diabetics patients.

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