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New-Generation Coronary Stents: Current Data and Future Directions

  • Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

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.

Summary

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.

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Abbreviations

BMS:

Bare metal stent

BVS:

Bioresorbable vascular scaffold

CoCr:

Cobalt-chromium

DAPT:

Dual antiplatelet therapy

DES:

Drug-eluting stent

ISR:

In-stent restenosis

MACE:

Major adverse cardiovascular event(s)

POBA:

Plain old balloon angioplasty

PCI:

Percutaneous coronary intervention

TLR:

Target lesion revascularization

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    Authors and Affiliations

    1. Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA

      Ankur Kalra, Hasan Rehman & Neal S. Kleiman

    2. Weill Cornell Medical College, New York, NY, USA

      Ankur Kalra & Neal S. Kleiman

    3. Safety, Quality, Informatics and Leadership Program, 2016-17, Harvard Medical School, Boston, MA, USA

      Ankur Kalra

    4. New York Medical College, White Plains, NY, USA

      Sahil Khera

    5. Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ, USA

      Braghadheeswar Thyagarajan

    6. Brigham and Women’s Heart and Vascular Center, Harvard Medical School, Boston, MA, USA

      Deepak L. Bhatt

    7. The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA

      Robert W. Yeh

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    Ankur Kalra, Hasan Rehman, Sahil Khera, Braghadheeswar Thyagarajan, Neal S. Kleiman, and Robert W. Yeh declare that they have no conflicts of interest.

    Deepak L. Bhatt discloses the following relationships—Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); and site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical; Trustee: American College of Cardiology; Unfunded Research: FlowCo, PLx Pharma, Takeda.

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    This article does not contain any studies with human or animal subjects performed by any of the authors.

    Additional information

    This article is part of the Topical Collection on Coronary Heart Disease

    Ankur Kalra and Hasan Rehman contributed equally to this work.

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    Kalra, A., Rehman, H., Khera, S. et al. New-Generation Coronary Stents: Current Data and Future Directions. Curr Atheroscler Rep 19, 14 (2017). https://doi.org/10.1007/s11883-017-0654-1

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