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November 2018

The Myths of the Bare-Metal Stent

Author Affiliations
  • 1The Christ Hospital Heart and Vascular Center, The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio
JAMA Cardiol. 2018;3(11):1039-1040. doi:10.1001/jamacardio.2018.3573

Coronary stent evolution with novel metal alloy composition, reduced strut thickness, enhanced platform flexibility and conformability, and improved polymer biocompatibility and/or bioresorption has been associated with progressive, step-wise reductions in major adverse cardiovascular events (MACE), including stent thrombosis (ST), compared with bare-metal stents (BMSs) as well as first-generation and newer-generation drug-eluting stents (DESs).1 The greatest differential in device-related events between these disparate platforms is in the first year following deployment; beyond 1 year, there is a 2% to 4% annual incidence of events regardless of device. Although BMSs have significantly higher rates of angiographic and clinical restenosis, their use is advocated for patients, “with a large vessel diameter in whom restenosis rates are low, those who cannot complete the longer duration of dual-antiplatelet therapy recommended for drug-eluting stents because of noncompliance or need for noncardiac surgery, those who cannot pay for drug-eluting stents or a longer duration of dual-antiplatelet therapy because of increased cost, and those at increased risk for bleeding.”2

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