Drug Eluting Stents and Bare metal stents - which one? What about the longterm results? Are we there still to decide which one is better ?

We know that  the Angioplasty alone is helpful in some lesions, angioplasty and stenting is helpful in some patients. But now we have an option to use the drug eluting stents or bare metal stents. The consensus is evolving and there seem to be still serious concerns about the use of the drug eluting stents and long term results. Recently long term results comparing the DES and BMS are examined and published in the JACC interventions.

DEDICATION trial showed that

Complete clinical status was available in 623 patients (99.5%) at 5 years follow-up. The combined MACE rate was insignificantly lower in the DES group (16.9% vs. 23%), mainly driven by a lower need of repeat revascularization (p = 0.07). Whereas the number of deaths from all causes tended to be higher in the DES group (16.3% vs. 12.1%, p = 0.17), cardiac mortality was significantly higher (7.7% vs. 3.2%, p = 0.02). The 5-year stent thrombosis rates were generally low and similar between the DES and the BMS groups. No cardiac deaths occurring within 1 month could be clearly ascribed to stent thrombosis, whereas stent thrombosis was involved in 78% of later-occurring deaths.

Conclusions  The 5-year MACE rate was insignificantly different, but the cardiac mortality was higher after DES versus BMS implantation in patients with STEMI. Stent thrombosis was the main cause of late cardiac deaths.

So, in the coming periods, how one can make an informed decision about using the drug eluting stents in clinical practice if these results are taken seriously. The drug eluting stents are expensive and we may say that BMS ( the less expensive) may be getting preference in the developing nations. But does that means there is a possibility that the absorbable drug eluting stents may stand a good chance as they not be associated with the late effects of drug eluting non absorbable stents. 

Long-Term Outcome After Drug-Eluting Versus Bare-Metal Stent Implantation in Patients With ST-Segment Elevation Myocardial Infarction5 Years Follow-Up From the Randomized DEDICATION Trial (Drug Elution and Distal Protection in Acute Myocardial Infarction)

Lene Holmvang, MD; Henning Kelbæk, MD; Anne Kaltoft, MD; Leif Thuesen, MD; Jens Flensted Lassen, MD; Peter Clemmensen, MD; Lene Kløvgaard, RN; Thomas Engstrøm, MD; Hans E. Bøtker, MD; Kari Saunamäki, MD; Lars R. Krusell, MD; Erik Jørgensen, MD; Hans-Henrik Tilsted, MD; Evald H. Christiansen, MD; Jan Ravkilde, MD; Lars Køber, MD; Klaus Fuglsang Kofoed, MD; Christian J. Terkelsen, MD; Steffen Helqvist, MD

J Am Coll Cardiol Intv. 2013;6(6):548-553. doi:10.1016/j.jcin.2012.12.129