Which Stents are Best – Drug-Eluting or Bare-Metal?

In the last year or so there have been competing reports about possible adverse outcomes with the two main types of stents for coronary atherosclerosis. A stent is a small, lattice-shaped, metal tube that is inserted permanently into an artery. The stent helps hold open an artery so that blood can flow through it. Stents were originally bare metal, but some years ago drug-eluting stents were introduced that contain drugs that can reduce the chance the arteries will become blocked again. Drug-eluting stents reduce restenosis (re-blockage) compared with bare-metal stents, but were thought to be associated with an increased risk of thrombosis in the stent.

The comparative benefits and risks of the two types of stents have been clarified by the results of a big study reported in the Journal of the American Medical Association. Results from some 39,000 patients who had bare-metal stents were compared with those from 28,000 patients who received sirolimus-eluting stents. Compared with bare-metal stents, those patients given drug-eluting stents were less likely to need a repeat ‘intervention’ or bypass surgery (17% vs. 20%, or 2.7% vs. 4.2%, respectively). This was at 2 years after the stent placement.

There was no difference in mortality risks at 2 years, but there was a small decrease in the EKG changes associated with a heart attack (ST-elevation) (2.4% vs. 2.0%) with  the durg-eluting stents.  So, when you cardiologist asks if you have any objection to placement of a drug-eluting stent, you can answer “no, Doctor, that’s fine by me”.