DES are to BMS as BMS were to PTCA alone

Translation:  Drug-eluting stents are to bare metal stents as bare metal stents were to percutaneous transluminal coronary angioplasty alone.

In the September 1 post on the meta-analysis by researchers at Tuft Medical Center, we noted the overall findings in general terms of the value of drug-eluting stents compared to bare metal stents.  It is worthwhile to provide the slightly more detailed conclusions of the authors:

"As a new technology, drug-eluting stents have now emerged as an important innovation in reducing coronary restenosis. To provide a precise estimate of their clinical benefit and to explore sources of statistical heterogeneity, we performed a meta-analysis of randomized controlled trials involving currently available drug-eluting stents using a DerSimonian and Laird random effects model. Our meta-analysis found no significant reduction in mortality or MI-free survival from the use of drug-eluting stents. However, drug-eluting stents clearly reduced the risk of restenosis by 23% and the risk for target lesion revascularization by 11% in the primary analysis. This is similar in magnitude to the benefit found for stents compared to balloon angioplasty. The need for revascularization after DES was 3.7% that is similar to the 3.8% observed after coronary artery bypass grafting and much lower than the 21% with bare-metal stents."

I have engaged in debate (I might actually call it "baiting") wtih those who have instead favored coronary artery bypass graft (CABG) surgery, which I view as a waning procedure compared to percutaneous methods (like angioplasty with stenting) that revascularize with minimal trauma to achieve clinically competitive outcomes.   I would argue that the most minimally invasive procedure is ultimately likely to resemble a percutaneous one anyway.  Indeed, if one were to project the future evolution of CABG, it would traverse a course from thoracotomy to endoscopy (thoracoscopy) to an intraluminal procedure (which garners negative feedback from surgeons; but, of course, when speaking with surgeons, I expect their answers to be geared toward the scalpel).

By comparison, drug-eluting stents are on a course toward an analogously less invasive option, which I envision as first, atherosclerosis-reducing drugs and, probably ultimately, gene therapy that preemptively addresses the incidence of atherosclerosis.  Right now, that is fantasy, but not by much.


See also the MedMarket Diligence report #C245 on the global market for coronary stents. 

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