New technologies for heart disease
Over the past 3 decades, percutaneous coronary intervention (PCI, or balloon angioplasty) has significantly changed the treatment of coronary artery disease (narrowing of the arteries supplying the heart muscle). Unlike the more invasive coronary artery bypass graft (CABG) surgery, angioplasty is a nonsurgical procedure in which a tiny catheter with a balloon is inserted into the coronary artery. The balloon is then inflated to push aside the plaque causing the narrowing. Often a stent (wire mesh tube) is left in place to help keep the treated artery open; however, restenosis, or repeat narrowing, of the artery can occur over time.
Drug-eluting stents were recently introduced to lower this risk of restenosis and have become an attractive alternative to bare-metal stents. However, they are much more expensive than bare-metal stents, and studies have shown no significant differences in rates of death or heart attack between patient groups receiving either type of stent.
Two articles that will appear in the Jan. 16, 2007, issue of CMAJ provide new insights into the use of drug-eluting stents.
The first is a research article by Grilli and colleagues in which they compare the use of drug-eluting stents for PCI in public versus private sectors of the Italian medical community. They also evaluate the effect