Downstream effects of coronary drug-eluting stents: Promising prophecy or incidental surveillance?

Evaluation of: Krasuski RA, Cater GM, Devendra GP et al. Downstream coronary effects of drug-eluting stents. Am. Heart J. 162, 764-771 e1 (2011). The remote effects of the cell-cycle inhibitors eluted from drug-eluting stents (DES) on downstream vessel architecture, remain controversial. The single-center cohort study reported by Krasuski et al. compared the incidence of angiographic de novo stenosis and the need for intervention in downstream vessels following proximal stent implantation, within 1 year 0f patients receiving a DES and bare-metal stent (BMS) from their registry, enrolling consecutive patients with percutaneous coronary intervention (PCI). DES use was associated with reduced risk of de novo stenosis and need for intervention in the overall cohort (Risk ratio [RR]: 0.39; 95% CI: 0.19-0.73; p < 0.01 for de novo stenosis, RR: 0.45; 95% CI: 0.21-0.85; p = 0.01 for need for intervention) and after propensity-matching (RR: 0.36; 95% CI: 0.14-0.82; p = 0.01 for de novo stenosis; RR: 0.41; 95% CI: 0.16-0.97; p = 0.04 for need for intervention). These findings may be explained by the remote effects of drugs released from DES, or may just be the result of individual differences in the progression of atherosclerosis.