Stents and going with the flow

A stent is a wire mesh tube used to prop open an artery and improve blood flow to the heart muscle. In recent years drug-eluting stents have been developed, which, as the name suggest, are coated with drugs that are slowly released and help keep the artery from reclosing, an occurrence known as restenosis.

In the first of three articles on sirolimus-eluting stents, in the February 1 issue of CMAJ, Yang and Moussa explain the mechanism of action of these types of stents and the clinical and scientific rationale behind their use within a wider context of interventional cardiology.

In a related article, Shrive and colleagues evaluate the economic impact of sirolimus-eluting stents given their high cost and widespread use and report they are cost-effective when used in patients at increased risk of restenosis or at high risk of death if another revascularization procedure were to be performed.

Otherwise, state the authors, their use is associated with a cost per quality-adjusted life-year that is similar to or higher than that of other accepted medical forms of treatment and carries a high incremental cost.

In a related commentary, Brophy calculates that sirolimus-eluting stents could consume $75 million of our health care budget. Given the inconclusive evidence on efficacy and long-term benefits of sirolimus-eluting stents and the limited budgets, Brophy suggests that increased alternative investments in more basic primary and secondary prevention and treatment programs could be a more prudent approach.

p. 323 Percutaneous coronary intervention and drug-eluting stents
-- Y.-M. Yang, I. Moussa

p. 345 Economic evaluation of sirolimus-eluting stents
-- F.M. Shrive et al

p. 361 The dollars and sense of drug-eluting stents
-- J.M. Brophy

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