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VIEWPOINT

Are Drug-Eluting Stents the Preferred Treatment for Multivessel Coronary Artery Disease?

Rush Medical College, Chicago, Illinois, and Clinical Cardiology Associates, Gottlieb Memorial Hospital, Melrose Park, Illinois

Manuscript received June 27, 2005; revised manuscript received August 1, 2005, accepted August 2, 2005.

^_* Reprint requests and correspondence: Dr. Lloyd W. Klein, Gottlieb Memorial Hospital, Professional Office Building Suite #314, 675 West North Avenue, Melrose Park, Illinois 60160. (Email: lloydklein{at}comcast.net).

Drug-eluting stents (DES) constitute a major breakthrough in restenosis prevention after initial percutaneous coronary intervention (PCI). Target lesion and vessel revascularization rates of <10% at six months follow-up represent a significant medical advance. Many cardiologists consider it reasonable to assume that PCI using DES ought to be considered equivalent, if not superior, to bypass surgery. The argument made is that in previous randomized clinical trials comparing PCI to coronary artery bypass grafting, restenosis was the determining factor favoring surgery, an event that clinical experience suggests is no longer as frequent. In the absence of a definitive clinical trial to support this view, how should the prudent, cutting edge cardiologist evaluate the data and manage their patients?

Abbreviations and Acronyms   ARTS = Arterial Revascularization Therapies Study   BMS = bare-metal stent   CABG = coronary artery bypass grafting   CAD = coronary artery disease   DES = drug-eluting stents   ERACI = Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty versus Coronary Artery Bypass Surgery in Multivessel Disease   PCI = percutaneous coronary intervention

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