Limited evidence for effectiveness of drug-eluting coronary artery stents

Clinical question: 
How effective are drug-eluting stents compared with bare metal stents in the reduction of cardiac events (angina or acute coronary syndrome)?
Bottom line: 
Drug-eluting stents are effective in reducing rates of restenosis but are not superior to standard bare metal stents in terms of decreasing deaths, myocardial infarction or thrombosis. Drug-eluting stents evaluated contained sirolimus, paclitaxel, dexamethasone, zotarolimus, everolimus and tacrolimus.
Caveat: 
The review was unable to report outcomes uniformly across all-time points and for all outcomes for all drugs. Long-term efficacy and safety data have not yet been confirmed as few trials reported outcomes beyond one or two years.
Context: 
Coronary artery stents are small, tubular devices used to “scaffold” vessels open during percutaneous transluminal coronary angioplasty. Restenosis of vessels treated with stents is a problem; in order to reduce restenosis, stents that elute drugs over time have been developed. However, there is a need to assess their clinical benefit prior to recommending their use. The increased cost of drug-eluting stents and current lack of evidence of their cost-effectiveness means that various health funding agencies are limiting or regulating their use.
Review CD#: 
CD004587
PEARLS No: 
274
Date: 
July, 2010
Authored by: 
Brian R McAvoy