Rapport benefice/risque des endoprotheses coronaires pharmaco-actives. 1ere partie: analyse dans la population generale.

Coronary drug-eluting stents (DES) are increasingly used in interventional cardiology. Stents coated with pharmacological substances such as sirolimus or paclitaxel, capable of reducing endothelial proliferation, have been proposed to replace bare-metal stents (BMS) in order to reduce the risk of restenosis. The survey of the literature confirms a major and significant reduction in the risk of restenosis with both sirolimus and paclitaxel DES as compared to BMS in the global population. This effect leads to a diminished requirement for new revascularisation procedures. However, such DES may increase the risk of very late stent thrombosis, presumably due to a defect of endothelialisation, which requires long-term effective antiplatelet therapy. The impact on major clinical coronary events shows no significant difference in mortality between DES and BMS. However, the incidence of myocardial infarct may be, slightly but significantly, reduced with sirolimus DES. In a next paper, the same analysis will be specifically performed in the diabetic population, which is well known to be at high risk of coronary heart disease, but is also expected to particularly benefit from DES.