Cost-effectiveness of drug-eluting stents: if only all things were equal

Derek PB Chew
Med J Aust 2005; 182 (8): . || doi: 10.5694/j.1326-5377.2005.tb06753.x
Published online: 18 April 2005

They reduce rates of restenosis but not mortality or infarction — so are they worth it?

The development of drug-eluting coronary stents has proven to be a quantum advance in interventional cardiology, rivalling the impact of stenting itself. Drug-eluting coronary stents deliver effective local concentrations of antiproliferative drugs (thus avoiding systemic toxicities), without substantially modifying the technique of percutaneous coronary intervention (PCI). Two of the drugs used are sirolimus and paclitaxel. Sirolimus is an inhibitor of the G1-phase of the cell cycle, while paclitaxel inhibits microtubule formation, both of which are necessary for cell division. Thus, they inhibit the natural healing mechanisms — endothelial cell migration and extracellular matrix formation — that produce intimal hyperplasia, resulting in restenosis.

  • Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA.


  • 1. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003; 349: 1315-1323.
  • 2. Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 2004; 350: 221-231.
  • 3. Babapulle MN, Joseph L, Belisle P, et al. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet 2004; 364: 583-591.
  • 4. Cohen DJ, Bakhai A, Shi C, et al. Cost-effectiveness of sirolimus-eluting stents for treatment of complex coronary stenoses: results from the Sirolimus-Eluting Balloon Expandable Stent in the Treatment of Patients With De Novo Native Coronary Artery Lesions (SIRIUS) trial. Circulation 2004; 110: 508-514.
  • 5. Laskey WK, Williams DO, Vlachos HA, et al. Changes in the practice of percutaneous coronary intervention: a comparison of enrollment waves in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry. Am J Cardiol 2001; 87: 964-969; A3-4.
  • 6. Stone GW, Ellis SG, Cox DA, et al. One-year clinical results with the slow-release, polymer-based, paclitaxel-eluting TAXUS stent: the TAXUS-IV trial. Circulation 2004; 109: 1942-1947.
  • 7. Mitka M. Drug-eluting stents show promise: but experts warn against enthusiasm outpacing science. JAMA 2004; 291: 682-683.
  • 8. Baim DS. New devices for percutaneous coronary intervention are rapidly making bypass surgery obsolete. Curr Opin Cardiol 2004; 19: 593-597.
  • 9. Kong DF, Eisenstein EL, Sketch MH Jr, et al. Economic impact of drug-eluting stents on hospital systems: a disease-state model. Am Heart J 2004; 147: 449-456.
  • 10. Eisenberg MJ. Drug-eluting stents: some bare facts. Lancet 2004; 364: 1466-1467.
  • 11. Teirstein PS. A chicken in every pot and a drug-eluting stent in every lesion. Circulation 2004; 109: 1906-1910.


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