Drug-eluting stents have been in use since 2002 and have clear advantages of reducing the risk of target vessel revascularization and a reduction in restenosis rate from 40% to less than 10%. These stents have potential role in reducing major cardiovascular outcomes, especially target vessel revascularization (TVR), compared with bare-metal stents.

A study reported on the clinical findings and 8-year follow-up parameters of all patients that underwent PCI with a drug-eluting stent from January 2002 to April 2007 at a single center. Total mortality was 8.7% and nonfatal infarctions were noted in 4.3% of the cases. Target vessel revascularization occurred in 12.4% of the cases, and target lesion revascularization occurred in 8%. The rate of stent thrombosis was 2.1%. No new episodes of stent thrombosis after the fifth year of follow-up were noted. Comparative subanalysis showed no outcome differences between the different types of stents used. These findings indicated that DES are safe and effective at very long-term follow-up and patients in the “real world” may benefit from these stents with excellent, long-term results.

Results of 13 years of the DESIRE (Drug-eluting Stents in the Real World) registry revealed that the use of DES was associated with very long-term safety and effectiveness with acceptable low rates of adverse clinical events, including stent thrombosis.

In a recent study in Indian unselected real world patients with coronary artery disease, MACE at the end of 12-month was 4.4%, consisting of 6 (1.8%) cases of cardiac death, 3 (0.9%) cases of MI, 5 (1.5%) cases of TLR and 1 (0.3%) case of TVR. There were 3 (0.9%) cases of ST at the end of 12-month. The cumulative event free-survival rate was found to be 95.6%. In this multicenter registry on real world population with coronary artery disease, everolimus-eluting stents demonstrated low event rate at up to 12-month follow-up.

The RESET trial has also shown that in patients undergoing PCI for mostly stable angina, EES is noninferior to SES for TLR at 12 months. This was maintained at 7 years of follow-up. The primary endpoint of TLR at 12 months was found to be similar between EES and SES (4.3% vs. 5.0%). Target vessel revascularization (TVR) rates were also similar (6.9% vs. 6.9%). Other endpoints including all-cause mortality (1.9% vs. 2.5%, p = 0.23), MI (3% vs. 3.5%, p = 0.42), and definite/probable stent thrombosis (0.32% vs. 0.38%, p = 0.77) were also similar. In the subset of patients undergoing angiographic follow-up, in-segment late loss at 8 months was similar (0.06 mm vs. 0.02 mm). Stent thrombosis rates at 7 years were shown to be extremely low with both stents (approximately 1%).