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Drug-eluting stents: Do they increase heart attack risk?

Drug-eluting stents, once thought to increase heart attack risk, are generally considered safe if used properly.

By Mayo Clinic staff

Stents are used to keep arteries open after a procedure called angioplasty. Some researchers had worried that a popular type of stent that slowly releases medication over time (drug-eluting stents) may actually increase a person's risk of having a heart attack.

However, since these concerns surfaced, a number of studies have shown that drug-eluting stents are safe and a good option for many people. Find out the differences between drug-eluting stents and bare-metal stents, what you should ask your doctor before having a stent placed, and what you should do after you get a drug-eluting stent.

What's a stent?

Stents are metal mesh tubes inserted during angioplasty. Angioplasty is a catheter procedure that involves temporarily inserting and blowing up a tiny balloon where your artery is clogged to help widen the artery. Stents help prevent restenosis — when the artery becomes blocked again. Without the use of stents, about 30 percent of arteries become blocked again.

There are two basic kinds of stents: bare-metal stents and drug-eluting stents.

  • Bare-metal stents are metal stents with no special coating. Bare-metal stents act as simple scaffolding to prop open blood vessels after they're widened with angioplasty. As the artery heals, tissue grows around the stent holding it in place. However, sometimes an overgrowth of this scar tissue in the arterial lining increases the risk that the artery will become blocked again.
  • Drug-eluting stents are coated with medication that is slowly released (eluted) to help prevent the growth of scar tissue in the artery lining. This helps the artery remain smooth and open, assuring good blood flow through it. Drug-eluting stents were developed because in some of those who get bare-metal stents, tissue growth over the stent eventually leads to re-blockage.

Many people with heart problems have been successfully treated with drug-eluting stents, preventing the need for more-invasive procedures, such as coronary artery bypass surgery. The reduced risk of re-narrowed arteries from drug-eluting stents reduces the need for repeat hospitalization and angioplasty procedures — each of which carry some risk of complications including heart attack and stroke.

What are your options for treating clogged heart arteries?

Drug-eluting stents are just one option for treating narrowed heart arteries. It's worth remembering that you basically have four options if your arteries become narrowed, each with risks:

  • Drug-eluting stents. Drug-eluting stents are safe and effective in most circumstances. The key to making this treatment option effective is that you must be willing to take your medications as they're prescribed. Medications can make it less likely that blood clots in your heart will dislodge and cause a heart attack. These stents work well and have a lower rate of restenosis than do bare-metal stents.
  • Bare-metal stents. These stents can work well, but have a higher rate of restenosis than do drug-eluting stents. If you'll need some type of surgery that's not related to your heart (for example, a stomach or hernia operation), soon after your stent placement, you may do better with a bare-metal stent.
  • Coronary bypass surgery. Bypass surgery is used to divert blood around blocked arteries in the heart. This surgery uses a healthy blood vessel taken from your leg, arm, or chest and connects it to the other arteries in your heart so that blood is bypassed around the diseased or blocked area. While bypass surgery works well, it's also more invasive than using stents, which means a longer recovery time. In addition, the risk of complications for bypass surgery can be higher than with stents.
  • Medications and lifestyle changes. This is a good option for many people. If you have symptoms from your narrowed coronary arteries, such as angina, and your condition isn't severe or immediately life-threatening, it may be worth first trying medications, such as statins, and lifestyle changes, such as eating a more balanced diet. This option can be as effective as receiving a stent, especially for those who don't have chest pain (angina). Keep in mind that even if you receive a stent, your doctor will likely also prescribe medications, such as statins, and lifestyle changes.
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References
  1. Stents. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/stents/stents_all.html. Accessed June 9, 2009.
  2. Stone GW. Safety and efficacy of sirolimus and paclitaxel-eluting coronary stents. New England Journal of Medicine. 2007;356:998.
  3. Stone GW. Paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction. New England Journal of Medicine. 2009;360:1946.
  4. Mauri L, et al. Drug-eluting or bare-metal stents for myocardial infarction. New England Journal of Medicine. 2008;359:1330.
  5. Mauri L, et al. Stent thrombosis in randomized clinical trials of drug-eluting stents. New England Journal of Medicine. 2007;356:1020.
  6. Malenka DJ, et al. Outcomes following coronary stenting in the era of bare-metal vs. era of drug-eluting stents. Journal of the American Medical Association. 2008;299:2868.
  7. Marroquin OC, et al. A comparison of bare-metal and drug-eluting stents for off-label indications. New England Journal of Medicine. 2008;358:342.

HB00090

July 16, 2009

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