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- BRR, binary restenosis rate
- CABG, coronary artery bypass graft surgery
- EPC, endothelial progenitor cell
- ISR, in-stent restenosis
- IVUS, intravascular ultrasound
- LMS, left main stem
- MACE, major adverse cardiac event
- mTOR, mammalian target of rapamycin
- PCI, percutaneous coronary intervention
- QCA, quantitative coronary angiography
- TLR, target lesion revascularisation
- TVR, target vessel revascularisation
In the last 3–5 years there has been a major shift in the management of symptomatic, obstructive coronary artery disease, with a move from predominantly surgical to increasingly a percutaneous approach. The perceived benefits of percutaneous coronary intervention (PCI) include patient convenience, ease of service expansion, and the fact that more complex lesions can now be undertaken through increases in operator skill and advances in balloon and stent technology. As a result there has been an exponential growth of PCI, with worldwide PCI rates exceeding surgical numbers for the last several years. The issue still to be decided is whether the percutaneous approach provides equivalent outcomes for all comers. This article will address the impact that drug eluting stents (DES) have had on improving the angioplasty result, what data are currently available to support different drug/platform combinations, and which issues still need to be resolved.
Improving the outcome after coronary stenting has been the goal since publication of the ARTS1 and SOS2 studies which, along with others, demonstrated the need for excess re-intervention in the stent arms in these studies of patients undergoing multivessel intervention. In the trials the differences were 14% and 15% at six months. Early studies with DES such as RAVEL3 suggested that such differences in re-intervention could be overcome, with very low restenosis rates being reported. However, as with all such developments it became clear that the patients treated in such early studies had lesions that could be regarded as relatively simple and therefore not representative of real world patients. The question to be asked in late 2004 early 2005 is: do the trials now represent real life and what are the current results?
Sirolimus, also known as rapamycin, is a macrolide and is the metabolic substrate of the fungus Streptomyces hygroscopicus. …