Drug-Eluting Stent Debate

ESC/WCC: Drug-Eluting Stent Debate Develops Fever Pitch - CME Teaching Brief® - MedPage Today: "BARCELONA, Spain, Sept 5 -- The long-term safety of drug-eluting stents suddenly eclipsed all other concerns this week at the world's largest gathering of cardiologists.
Many of the more than 25,000 cardiologists meeting here are shaking their heads in disbelief at the meta-analysis data that raised serious questions about the long-term safety of the coated devices.
The two meta-analyses reported Sunday at the Europeans Society of Cardiology/World Congress of Cardiology have highlighted 'the dark side of drug-eluting stents,' as Robert Harrington, M.D., of Duke put it.
Dr. Harrington's 'dark-side' is the finding that first generation drug-eluting stents are associated with an increased risk of late stent thrombosis, an increased cardiac mortality, an increased risk of myocardial infarction, and an increased risk of all cause mortality.
But even as every hallway buzzed with the grim potentialities, should the meta-analyses be borne out by prospective randomized studies, a new positive report emerged about the drug-eluting stents. This was a report of an investigational device showing that that it was superior to one of the two already approved stents.
That device is just one of a handful of second- and third- generation drug-eluting stents wending their way through the approval process.
Weighing the darker and the brighter sides of drug eluting stents has been the focus of heated discussions here, inside and outside the sessions.
An estimated six million of the first generation drug eluting stents-Cypher, a sirolimus-eluting stent, and Taxus, which elutes paclitaxel-have been implanted.
The meta-analyses reported here found that Cypher had significant risks compared with bare metal stents" /.../