Ankur Kalra1,2,3, Hasan Rehman1, Sahil Khera4, Braghadheeswar Thyagarajan5, Deepak L Bhatt6, Neal S Kleiman1,2, Robert W Yeh7. 1. Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA. 2. Weill Cornell Medical College, New York, NY, USA. 3. Safety, Quality, Informatics and Leadership Program, 2016-17, Harvard Medical School, Boston, MA, USA. 4. New York Medical College, White Plains, NY, USA. 5. Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA. 6. Brigham and Women's Heart and Vascular Center, Harvard Medical School, Boston, MA, USA. 7. The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA. ryeh@bidmc.harvard.edu.
Abstract
PURPOSE OF REVIEW: Drug-eluting stents are the mainstay in the treatment of coronary artery disease using percutaneous coronary intervention. Innovations developed to overcome the limitations of prior generations of stents include biodegradable polymer stents, drug-eluting stents without a polymer, and bioabsorbable scaffolds. Our review briefly discusses the clinical profiles of first- and second-generation coronary stents, and provides an up-to-date overview of design, technology, and clinical safety and efficacy profiles of newer generation coronary stents discussing the relevant clinical trials in this rapidly evolving area of interventional cardiology. RECENT FINDINGS: Drug-eluting stents have previously been shown to be superior to bare metal stents. Second-generation everolimus-eluting stents have proven to have superior outcomes compared with first-generation paclitaxel- and sirolimus-eluting stents, and the second-generation zotarolimus-eluting stents appear to be similar to the everolimus-eluting stents, though with a lesser degree of evidence. Stents with biodegradable polymers have not been shown to be superior to everolimus-eluting stents. Bioabsorbable scaffolds have not demonstrated better outcomes than current standard treatment with second-generation drug-eluting stents but have showed a concerning signal of late and very late stent thrombosis. Everolimus-eluting stents have the most favorable outcomes in terms of safety as well as efficacy in patients undergoing percutaneous coronary intervention. Newer innovations such as biodegradable polymers and bioabsorbable scaffolds lack clinical data to replace second-generation drug-eluting stents as standard of care.
PURPOSE OF REVIEW: Drug-eluting stents are the mainstay in the treatment of coronary artery disease using percutaneous coronary intervention. Innovations developed to overcome the limitations of prior generations of stents include biodegradable polymer stents, drug-eluting stents without a polymer, and bioabsorbable scaffolds. Our review briefly discusses the clinical profiles of first- and second-generation coronary stents, and provides an up-to-date overview of design, technology, and clinical safety and efficacy profiles of newer generation coronary stents discussing the relevant clinical trials in this rapidly evolving area of interventional cardiology. RECENT FINDINGS: Drug-eluting stents have previously been shown to be superior to bare metal stents. Second-generation everolimus-eluting stents have proven to have superior outcomes compared with first-generation paclitaxel- and sirolimus-eluting stents, and the second-generation zotarolimus-eluting stents appear to be similar to the everolimus-eluting stents, though with a lesser degree of evidence. Stents with biodegradable polymers have not been shown to be superior to everolimus-eluting stents. Bioabsorbable scaffolds have not demonstrated better outcomes than current standard treatment with second-generation drug-eluting stents but have showed a concerning signal of late and very late stent thrombosis. Everolimus-eluting stents have the most favorable outcomes in terms of safety as well as efficacy in patients undergoing percutaneous coronary intervention. Newer innovations such as biodegradable polymers and bioabsorbable scaffolds lack clinical data to replace second-generation drug-eluting stents as standard of care.
Authors: Patrick W Serruys; Sigmund Silber; Scot Garg; Robert Jan van Geuns; Gert Richardt; Pawel E Buszman; Henning Kelbaek; Adrianus Johannes van Boven; Sjoerd H Hofma; Axel Linke; Volker Klauss; William Wijns; Carlos Macaya; Philippe Garot; Carlo DiMario; Ganesh Manoharan; Ran Kornowski; Thomas Ischinger; Antonio Bartorelli; Jacintha Ronden; Marco Bressers; Pierre Gobbens; Manuela Negoita; Frank van Leeuwen; Stephan Windecker Journal: N Engl J Med Date: 2010-06-16 Impact factor: 91.245
Authors: G S Mintz; J J Popma; A D Pichard; K M Kent; L F Satler; C Wong; M K Hong; J A Kovach; M B Leon Journal: Circulation Date: 1996-07-01 Impact factor: 29.690
Authors: Gregg W Stone; Paul S Teirstein; Ian T Meredith; Bruno Farah; Christophe L Dubois; Robert L Feldman; Joseph Dens; Nobuhisa Hagiwara; Dominic J Allocco; Keith D Dawkins Journal: J Am Coll Cardiol Date: 2011-04-04 Impact factor: 24.094
Authors: Patrick W Serruys; Joost Daemen; Marie-Claude Morice; Bernard De Bruyne; Antonio Colombo; Carlos Macaya; Gert Richardt; Jean Fajadet; Christian Hamm; Keith D Dawkins; Pascal Vranckx; Marco Bressers; Ron van Domburg; Monique Schuijer; Kristel Wittebols; Magdaleen Pieters; Hans Peter Stoll Journal: EuroIntervention Date: 2008-01 Impact factor: 6.534
Authors: Ian T Meredith; Paul S Teirstein; Alain Bouchard; Didier Carrié; Helge Möllmann; Keith G Oldroyd; Jack Hall; Dominic J Allocco; Keith D Dawkins; Gregg W Stone Journal: Am J Cardiol Date: 2014-01-14 Impact factor: 2.778
Authors: Sripal Bangalore; Sunil Kumar; Mario Fusaro; Nicholas Amoroso; Michael J Attubato; Frederick Feit; Deepak L Bhatt; James Slater Journal: Circulation Date: 2012-05-14 Impact factor: 29.690
Authors: Madhavi Duvvuri; Kevin Motz; Michael Murphy; Michael Feeley; Dacheng Ding; Andrew Lee; Jennifer H Elisseeff; Alexander T Hillel Journal: Biomater Sci Date: 2019-04-23 Impact factor: 6.843
Authors: Madhavi Duvvuri; Kevin Motz; Hsiu-Wen Tsai; Ioan Lina; Dacheng Ding; Andrew Lee; Alexander T Hillel Journal: J Vis Exp Date: 2020-01-21 Impact factor: 1.355
Authors: Yerin Kim; Jun Kyu Park; Jun-Hyuk Seo; Hyun-Seung Ryu; Kyung Seob Lim; Myung Ho Jeong; Dong Hoon Kang; Sang Won Kang Journal: Sci Rep Date: 2018-11-08 Impact factor: 4.379
Authors: Raja Chakraborty; Payel Chatterjee; Jui M Dave; Allison C Ostriker; Daniel M Greif; Eva M Rzucidlo; Kathleen A Martin Journal: JVS Vasc Sci Date: 2021-05-15