Drug Eluting Stents

Paper Summary:

The paper discusses patients with coronary artery disease that undergo coronary angioplasty and relates that one of the main limitations of angioplasty is the relatively high rate of restenosis after surgery. The paper further confirms that stents used during angioplasty to provide a metal scaffold reduce the chance of vessel re-stenosis. The paper discusses how the introduction of drug eluting stents dramatically reduced the incidence of re-stenosis. Ths paper researches whether patients receiving drug-eluting stents (DES) experience decreased incidences of reoccurring myocardial infarction compared to patients receiving bare metal stents (BMS).

Outline:
Clinical Question
Search for Studies
Comparison of Two Articles

From the Paper:

"A search of CINAHL using a key word search and BOOLEAN operators "drug eluting stents AND bare metal stents" resulted in 22 journal returns, two of which contained systematic reviews. It was less effective to select the operation to "find similar articles" in CINAHL than in MEDLINE, since several times the request returned no records, while in MEDLINE simply selecting one of the results would also open a menu of similar articles. Using limitation or truncation symbols resulted in zero search results. CINAHL searches were especially helpful since in the journal listing it describes the results in terms of meta-analysis, RCT, etc.
Google Scholar does not allow the use of Boolean operators to limit results, and therefore a search for keywords "drug eluting stents and bare metal stents" returned a total of 3,620 results. Some results were as obscure as the use of stents in porcine models. Google Scholar does allow a search using the Advance Scholar operations, which increases accuracy of the search by adding operators not recognized by the Google Scholar search box. Advanced operator options in the Google Scholar advanced search include the +, - and OR operators, which were not helpful in narrowing the results. The "intitle" operator was the most useful operator, returning two results, one of which was a 170 page systematic review of cost effectiveness of drug eluting stents versus bare metal stents."

Sample of Sources Used:

• Kaiser, C, Brunner-La Rocca HP, Buser PT, Bonetti PO, Osswald S, Linka A, Bernheim A, Zutter A, Zellweger M, Grize L, Pfisterer ME. (2005) Incremental cost-effectiveness of drug-eluting stents compared with a third-generation bare-metal stent in a real-world setting: randomized Basel Stent Kosten Effektivitats Trial (BASKET). The Lancet, 366:921-929
• Katritsis, E. & Karvouni, J. Ioannidis Meta-analysis comparing drug-eluting stents with bare metal stents. The American Journal of Cardiology, 95, 5: 640-643
• Hill, R., Bagust, A., Dickson, R., Dundar, Y., Haycox, A., Mujica Mota, R., Reaney, A., Roberts, D., Willliamson, P., Walley, T. (2004) Coronary artery stents: a rapid systematic review and economic evaluation. Health Technol Assess. 8; 1-242.
• Pasceri, V., Patti, G., Speciale, C., Pristipino, P., Richichi, G. & Di Sciascio, G. (2007) Meta-analysis of clinical trials on use of drug-eluting stents for treatment of acute myocardial infarction. Am Heart J. 153; 749-754
• Groeneveld. P.W., Suh, J.J. & Matta, M.A. (2007) The costs and quality-of-life outcomes of drug-eluting coronary stents: a systematic review. J Interv Cardiol. 20:1-9

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