Coronary Angioplasty and Drug-Eluting Stents - Applications of Biotechnology in Cardiovascular Therapeutics - page 295

procedures as compared with treatment with BMS (Mauri et al. 2008 ). Another
study has evaluated 47,967 patients in Sweden who received a coronary stent and
were entered into the Swedish Coronary Angiography and Angioplasty Registry
between 2003 and 2006 and for whom complete follow-up data were available for
1-5 years (James et al. 2009 ). In the primary analysis, patients who received one
DES (10,294 patients) were compared with those who received one BMS (18,659),
after adjustment for differences in clinical characteristics of the patients and char-
acteristics of the vessels and lesions. As compared with BMS, DES are associated
with a similar long-term incidence of death or myocardial infarction and provide a
clinically important decrease in the rate of restenosis among high-risk patients.
In a randomized study, patients requiring stenting of large (3 mm diameter)
coronary arteries, no significant differences were found among sirolimus-eluting,
everolimus-eluting, and BMS with respect to the rate of death or myocardial infarc-
tion (Kaiser et al. 2010 ). With the two DES', similar reductions in rates of target-
vessel revascularization were seen.
Guidelines for DES Versus BMS
The Task Force on Practice Guidelines of American College of Cardiology/
American Heart Association has published the 2007 update of the2005 guidelines
for percutaneous coronary intervention (King et al. 2007 ). The following are rele-
vant to DES versus BMS:
1. A DES should be considered as an alternative to a BMS in those patients for
whom clinical trials indicate a favorable effectiveness/safety profile. (Level of
Evidence: A).
2. Before implanting a DES, the interventional cardiologist should discuss with the
patient the need for and duration of DAT and confirm the patient's ability to
comply with the recommended therapy for DES. (Level of Evidence: B).
3. In patients who are undergoing preparation for PCI and are likely to require
invasive or surgical procedures for which DAT must be interrupted during the
next 12 months, consideration should be given to implantation of a BMS or per-
formance of balloon angioplasty with a provisional stent implantation instead of
the routine use of a DES. (Level of Evidence: C).
DES Versus BMS for Off-Label Indications
Off-label use of stenting is defined as application in restenotic lesions, lesions in a
bypass graft, left main coronary artery disease, or ostial, bifurcated, or totally
occluded lesions, as well as use in patients with a reference-vessel diameter of less
than 2.5 mm or greater than 3.75 mm or a lesion length of more than 30 mm. Both
BMS and DES have been used for off-label indications and one study has compared
the use of BMS with DES in off-label indications in patients who were followed for
1 year for the occurrence of cardiovascular events and death (Marroquin et al. 2008 ).