Second generation drug-eluting stents: a focus on safety and efficacy of current devices

ABSTRACT

Introduction: Percutaneous coronary intervention (PCI) represents the most frequent procedure performed in medicine. Second generation drug eluting stents (DES) have been developed to reduce the rates of late and very late complications of first generation DES.

Areas covered: To improve long-term efficacy and safety of patients undergoing PCI, second generation DES have been developed with novel stent platforms, biocompatible durable and biodegradable polymers and newer antiproliferative agents. In this review we provide an overview of second generation DES and their clinical trials, discussing safety and effectiveness of these devices, and outlining clinical indication for use.

Expert commentary: Numerous clinical trials have demonstrated the safety and efficacy of second generation DES over the last decade. These devices represent the gold standard treatment in stable and acute coronary syndromes.

KEYWORDS:

• Biodegradable polymer
• drug-eluting stent
• durable polymer
• percutaneous coronary intervention
• second generation

Article highlights

• Second generation DES represent the gold standard treatment in stable and acute coronary disease.

• Second generation DES demonstrated better outcomes than BMS.

• Second generation DES reduced the incidence of late and very late complications related to first generation DES.

• Newer thinner strut DES appeared to improve outcomes compared with second generation DES.

• In diabetic patients, EES seems to be the most efficacious and safe, even though the new Cre8^TM stent seems to have better performance in this clinical context.

• A short-term (≤6 months) DAPT is as safe and efficacious as long-term (≥12 months) DAPT after second generation DES implantation.

• Left Main PCI with second generation DES is as safe and efficacious as CABG in patients with low to intermediate SYNTAX score.

• CABG remains the preferred revascularization strategy for multivessel disease.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.