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Controversies in Cardiology pp 333–347Cite as

Role of Oral Therapies in the Prevention of Coronary Restenosis: Insights from Randomized Clinical Trials

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Abstract

Neo intimal hyperplasia after implantation of a bare metal stent (BMS) has become the main pathophysiology mechanism of coronary restenosis and stent failure during percutaneous coronary interventions (PCI). The use of drug eluting stents (DES) with local immunosuppressive drugs minimized the high frequency of in stent restenosis (ISR) observed after PCI with BMS and significantly reduced the risk of re-intervention. However, in spite of the world wide penetration of DES, in the USA, a quarter of PCI-patients still receive BMS and according to recent data, the market for BMS globally contributed around 40–45 % of the global coronary stent market in 2010 and it is expected to grow at a rate of 2 % between 2011 and 2016. BMS use is particularly high (over 50 %) in certain geographic areas with socioeconomic issues. Thus, many contemporary PCI-patients do not receive DES and are at a higher risk of restenosis. In the last decade, simultaneous with the introduction of DES, oral immunosuppressive or anti-inflammatory drugs given after BMS implantation have been used to reduce neo-intimal hyperplasia and ISR. From anti-inflammatory drugs such as prednisone or colchicine to immunosuppressive drugs like sirolimus, data are now available and several randomized studies had been conducted and reported their results, some of them at long term. However, in spite of these positive reports, none of these agents are included within revascularization guidelines. In this chapter, we review all randomized data in an attempt to find a clinical indication for these oral agents.

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Authors and Affiliations

  1. Cardiovascular Research Center (CECI), Capital Federal, Ciudad de Buenos Aires, Argentina

    A. Matías Rodríguez-Granillo MD

  2. Interventional Cardiology Department, Sanatorio Las Lomas, Avda Diego Carman 555, San Isidro, Buenos Aires, B 555, Argentina

    Omar Santaera MD

  3. Cardiac Unit, Department of Interventional Cardiology, Revista Argentina de Cardioagiologia Intervencionista (RACI), Otamendi Hospital, Buenos Aires, Argentina

    Alfredo E. Rodríguez MD, PhD, FACC, FSCAI (Director)

  4. Cardiovascular Research Center (CECI), Buenos Aires, Argentina

    Alfredo E. Rodríguez MD, PhD, FACC, FSCAI (Director)

  5. Interventional Cardiology Unit, Department of Interventional Cardiology, Otamendi Hospital, Buenos Aires, Argentina

    Alfredo E. Rodríguez MD, PhD, FACC, FSCAI (Director)

  6. University of Buenos Aires, Post-Graduate Buenos Aires School of Medicine, Buenos Aires, Argentina

    Alfredo E. Rodríguez MD, PhD, FACC, FSCAI (Director)

Authors
  1. A. Matías Rodríguez-Granillo MD
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  2. Omar Santaera MD
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  3. Alfredo E. Rodríguez MD, PhD, FACC, FSCAI
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Corresponding author

Correspondence to A. Matías Rodríguez-Granillo MD .

Editor information

Editors and Affiliations

  1. UCSF Fresno, Fresno, California, USA

    John A. Ambrose

  2. Department of Interventional Cardiology, Otamendi Hospital, Buenos Aires, Argentina

    Alfredo E. Rodríguez

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Rodríguez-Granillo, A.M., Santaera, O., Rodríguez, A.E. (2015). Role of Oral Therapies in the Prevention of Coronary Restenosis: Insights from Randomized Clinical Trials. In: Ambrose, J., Rodríguez, A. (eds) Controversies in Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-319-20415-4_22

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