Drug-Eluting Stents Reduce Restenosis Risk, But Not Mortality

The findings from a meta-analysis of trial data indicate that sirolimus- or paclitaxel-eluting stents are better than their bare-metal counterparts at preventing angiographic restenosis and major cardiac events. Still, there is no evidence that using such stents influences mortality or myocardial infarction rates.

The results, which appear in the August 14th issue of The Lancet, are based on analysis of data from 11 trials that included a total of 5103 patients who were treated with stents for coronary heart disease. Each trial was randomized and featured 6 to 12 months of clinical follow-up.

The major cardiac event rate for patients treated with drug-eluting stents was 7.8%, less than half the rate seen in patients treated with bare-metal stents (16.4%), Dr. Mark J. Eisenberg, from Jewish General Hospital in Montreal, and colleagues note. Moreover, the angiographic restenosis rate in the drug-eluting stent group was 8.9%, much lower than the 29.3% rate in the bare-metal stent group.

Despite these apparent benefits for drug-eluting stents, mortality and myocardial infarction rates were comparable for patients treated with either stent type, the researchers point out.

Although drug-eluting stents appeared to be safe over medium-term follow-up, the authors note that current data are “too sparse for firm conclusions to be drawn.”

In a related editorial, Dr. Joachim Schofer and Dr. Michael Schluter, from Othmarscher Kirchenweg in Hamburg, Germany, comment that although the findings suggest beneficial clinical effects, “long-term outcomes in higher-risk patient/lesion cohorts are needed before drug-eluting stents deserve the term panacea.”

Lancet 2004;364:558-559,583-591.