Stents And The Leveling Of The Anatomic Playing Field

As summarized in Table 4-7, both bare metal stents and drug-eluting stents have been tested, by randomized trial and/or registry, in a number of the anatomic classifications that the ACC/AHA lesion scheme defined as high-risk.5 The reductions in both acute and long-term adverse outcomes and improvements in clinical success are major components of the broadening of the anatomic application of PCI to relief of myocardial ischemia. A major test of this "leveling of the anatomic playing field" hypothesis will be whether the proportion of screened patients who are enrolled in the trials of drug-eluting stents versus CABG, such as the National Institutes of Health (NIH)-sponsored Future Revascularization Evaluation in patiEnts with Diabetes mellitus: Optimal Management of multivessel disease (FREEDOM) trial, is not considerably higher than the less than 10% of almost all of the trials of pre-stent PCI versus CABG (see Table 4-3).2,8

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