Effectiveness of drug-eluting stents in the treatment of coronary artery disease

ABSTRACT

Strength of Recommendations: Weak in favor of the technology

Technology: Drug-Eluting Stent

Indication: Increase in coronary luminal diameter and reducing restenosis stent for treatment of patients with coronary artery disease.

Characterization of the technology: Tubular structures of metal, coated with a polymer and an antiproliferative agent. These structures are used to hold the arterial lumen open and prevent restenosis of the lesion and target vessel, by means of mechanical pressure and local administration of drugs.

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

Search and analysis of scientific evidence: We searched the Medline and EMBASE and included observational studies comparing DES with each other or compared to BMS for treatment of patients with coronary artery disease. We searched Technology Assessments (HTA) studies in national and international agencies websites.

Summary of results of selected studies: We selected four HTA and 34 observational studies, of which five were cohort studies and the remaining 19 registry studies published between 2005 and 2012, with mean follow-up ranging between six and 48 months. Among the selected observational studies, 27 studies (79.4%) were prospective. DES failed to reduce the mortality rate, incidence of myocardial infarction (MI) or stroke compared with BMS. There was a reduction in the rate of revascularization using sirolimus eluting stent (SES) compared to BMS. Regarding the comparison of DES with each other, there was no significant difference regarding mortality and MI. Diabetic patients were evaluated in SES vs. BMS and PES vs. BMS comparisons and there was no difference between groups for the primary outcomes. HTA studies recommended the use of DES if the cost of this technology is considered acceptable, by medical criteria and for the subgroup of patients considered at high risk of restenosis.

Recommendations: Based on available evidence of effectiveness and safety and the results HTA found, we weakly recommend the use of drug eluting stents for patients with coronary artery disease who have complex lesion anatomy and for patients at high risk of being subjected to reintervention, such as diabetics.

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