From the Guidelines
The primary difference between bare metal stents (BMS) and drug-eluting stents (DES) lies in their structure and the impact on dual antiplatelet therapy (DAPT) duration, with BMS generally requiring at least 1 month of DAPT and DES requiring 6-12 months due to delayed endothelialization and increased stent thrombosis risk. The choice between BMS and DES, and the subsequent DAPT duration, is influenced by the patient's specific clinical presentation, including the presence of acute coronary syndromes (ACS) or stable ischemic heart disease (SIHD), as well as factors such as bleeding risk and comorbidities 1.
Key Considerations for DAPT Duration
- For BMS, a minimum duration of DAPT of 1 month is generally recommended, with some guidelines suggesting up to 6 months, due to the high risk of stent thrombosis in the first days to weeks after implantation 1.
- For DES, the recommended minimum duration of DAPT has been decreased from 12 to 6 months in patients with SIHD, based on the lower risk of stent thrombosis with newer-generation DES 1.
- In patients with ACS, the recommendation for DAPT duration is at least 12 months, regardless of the type of stent implanted, with the option to consider prolongation beyond 12 months in patients who have tolerated DAPT without a bleeding complication and are not at high bleeding risk 2.
- Patient-specific factors, such as bleeding risk, stent location, and comorbidities, should always be considered when determining the optimal DAPT duration for each individual 1, 2.
Impact on Morbidity, Mortality, and Quality of Life
The choice of stent and DAPT duration has significant implications for morbidity, mortality, and quality of life. Prolonged DAPT can reduce the risk of stent thrombosis and ischemic events, but also increases the risk of bleeding complications. Therefore, a thoughtful assessment of the benefit/risk ratio is necessary to determine the optimal DAPT duration for each patient 1.
Clinical Decision-Making
In clinical practice, the decision to use BMS or DES, and the subsequent DAPT duration, should be individualized based on the patient's specific clinical presentation and risk factors. The most recent and highest quality evidence should be used to guide clinical decision-making, with consideration of patient-specific factors and the potential risks and benefits of different treatment strategies 1, 2.
From the Research
Difference between Bare Metal Stent and Drug Eluting Stent
- Bare metal stents are made of metal and do not release any medication, whereas drug eluting stents release medication to prevent cell proliferation and reduce the risk of restenosis 3.
- The main difference between the two types of stents is the presence of a drug coating on the drug eluting stent, which helps to prevent the growth of tissue and reduce the risk of blockage 4.
Influence on Duration of DAPT
- The duration of dual antiplatelet therapy (DAPT) may vary depending on the type of stent used, with drug eluting stents typically requiring a longer duration of DAPT compared to bare metal stents 3, 4.
- Studies have shown that prolonged DAPT (>12 months) is associated with a lower risk of death and myocardial infarction in patients with both bare metal and drug eluting stents, but the effect is greater for drug eluting stents 3.
- However, the optimal duration of DAPT is still a topic of debate, and the decision to extend or shorten DAPT should be individualized based on the patient's risk of bleeding and ischemic events 4, 5.
- Some studies have suggested that a shorter duration of DAPT (1-3 months) may be sufficient for patients with high bleeding risk, but this approach requires further investigation 5.
- The type of antiplatelet therapy used, including the dose of aspirin, may also influence the duration of DAPT, but the evidence is limited and inconclusive 6, 7.