Comparison of drug-eluting intracoronary stents
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
- J Dawn Abbott, MD, FACC
J Dawn Abbott, MD, FACC
- Associate Professor of Medicine
- Brown Medical School
Drug-eluting stents (DES) were developed to overcome the relatively high rates of restenosis and target lesion revascularization with bare metal stents. Indeed, the rate of target lesion revascularization is lowered by as much as 65 percent. (See "Clinical use of intracoronary bare metal stents", section on 'When to choose a BMS'.)
All DES currently approved in the United States have the same general components, although they differ with respect to the stent platform, polymer, and antirestenotic drug type (table 1). Differences may be observed with respect to deliverability (ease of placement), efficacy (prevention of restenosis), and safety (rates of stent thrombosis and myocardial infarction).
The first two DES to be approved in the United States were the sirolimus-eluting stent (SES) in 2003 and paclitaxel-eluting stent (PES) in 2004. They are now often referred to as "first generation" DES. SES are no longer available in the United States and Europe and PES are infrequently used due to superiority of second generation stents. (See "Clinical use of intracoronary bare metal stents".)
In 2008, the zotarolimus-eluting stent (ZES) and the everolimus-eluting stent (EES) were approved for use and they are referred to as "second generation" DES. The ZES has undergone further modification with a change in polymer to modify pharmacokinetics and has largely replaced the earlier version. The newer DES have a stent platform of a cobalt-or platinum-chromium alloy and are thinner and more deliverable than the first generation DES. In addition, second generation DES are more biocompatible than first generation DES: They may generate less inflammatory response and have more rapid vessel endothelialization or healing. This biocompatibility and associated reduced inflammatory response is likely due to improvements in polymer technology and may translate into lower rates of myocardial infarction and stent thrombosis. However, despite this potential improvement in biocompatibility, the recommended duration of dual antiplatelet therapy with aspirin and a P2Y12 receptor blocker is 12 months, similar to the first generation DES. (See "Long-term antiplatelet therapy after coronary artery stenting in stable patients", section on 'Summary and recommendations'.)
This topic will review the studies that compared one DES to another and make recommendations for which DES to choose in patients for whom DES are chosen. The discussion of the choice between DES and bare metal stents is found elsewhere (see "Clinical use of intracoronary bare metal stents", section on 'When to choose a BMS'). Other drug-eluting stents, including stents with polymers that are bioabsorbable, or fully bioresorbable stents, are discussed separately. (See "Bioresorbable polymer or scaffold drug-eluting coronary artery stents".)
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- SIROLIMUS AND PACLITAXEL STENTS
- EVEROLIMUS-ELUTING STENTS
- Compared with PES
- Compared with SES
- Available EES
- ZOTAROLIMUS-ELUTING STENTS
- EVEROLIMUS- VERSUS ZOTAROLIMUS-ELUTING STENTS
- COMPARISON OF ALL DES
- OUR APPROACH
- RECOMMENDATIONS OF OTHERS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS