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REVIEW

Narrative Review: Drug-Eluting Stents for the Management of Restenosis: A Critical Appraisal of the Evidence

Roderick Tung, MD; Sanjay Kaul, MD; George A. Diamond, MD; and Prediman K. Shah, MD

20 June 2006 | Volume 144 Issue 12 | Pages 913-919

Interventional cardiologists have quickly replaced bare metal stents with intravascular drug-eluting stents for treating and preventing restenosis, largely on the basis of empirical evidence that shows profound reduction in angiographic and clinical restenosis. A critical reassessment of the published evidence, however, suggests that the putative superiority of intravascular drug-eluting stents is founded on questionable premises, including 1) overestimation of restenosis benefit, 2) underestimation of the risk for stent thrombosis, 3) overreliance on "soft" rather than "hard" outcomes (need for repeated revascularization vs. death or myocardial infarction), and 4) the attendant overestimation of cost-effectiveness. Because the long-term incremental risks, benefits, and costs of drug-eluting stents have not yet been optimally evaluated in a broad spectrum of patient and lesion cohorts, the rational role of these devices in clinical management warrants reappraisal.

Author and Article Information

From Cedars-Sinai Medical Center, David Geffen School of Medicine, and University of California, Los Angeles, Los Angeles, California.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Sanjay Kaul, MD, Division of Cardiology, Room 5536, South Tower, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048.

Current Author Addresses: Drs. Tung, Kaul, Diamond, and Shah: Division of Cardiology, Room 5536, South Tower, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048.

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