Critics Say Drug-Eluting Stents Overused

Abstract

THE APPEARANCE A FEW YEARS AGO of drug-eluting stents as a tool for the treatment of coronary vessel stenosis was hailed by most of the cardiology community as a major advance over bare-metal stents. Now, findings from 2 studies presented in September at the World Congress of Cardiology in Barcelona, Spain, have dampened that enthusiasm. The studies’ findings give ammunition to those who suggest percutaneous coronary intervention (PCI) using drug-eluting stents was being oversold in light of a lack of evidence surrounding long-term safety and efficacy—especially in patients with stable chronic angina, a relatively benign condition. “With about 2 million being performed annually, PCIs are being overused,” warned Salim Yusuf, MD, DPhil, a professor of medicine at McMaster University, Hamilton, Ontario, who has been critical of stenting (Rihal CS et al. Circulation. 2003;108:2439-2445). “There have been good trials showing that PCI for patients with stable angina has no advantage over medical treatment.” And now there is a suggestion that long-term use of drug-eluting stents increases the chances of coronary artery thrombosis and death. The working theory is that to prevent restenosis, the stent sites never fully heal, which increases the risk of developing blood clots.