[Insulin-dependent. Rapamycin-resistant?].

The development of drug-eluting stents has revolutionized interventional cardiology. In Spain, 25 148 drug-eluting stents were implanted in 2004, according to the Registro Español de Hemodinámica y Cardiología Intervencionista (Spanish Registry of Hemodynamics and Interventional Cardiology).1 Based on the results of key randomized studies with sirolimuseluting2,3 and paclitaxel-eluting stents,4-7 everything appears to indicate that the efforts to prevent the muchdreaded restenosis have finally been successful. In fact, when one reads or reviews the main large-scale, multicenter, multinational, often industry-sponsored studies, the conclusion is that these stents have a high level of efficacy and safety. A meta-analysis of 12 clinical studies8 showed a mean reduction in the revascularization incidence of 69% (relative risk [RR]=0.31; 95% confidence interval, 0.19-0.51). This benefit was associated with a mean additional cost of €818 718 per 1000 patients with a de novo lesion treated with a drug-eluting stent. Therefore, widespread use at market prices would imply an increase in healthcare costs for the different sensitivity scenarios assessed. It has recently been shown that the use of drugeluting stents may have greater cost-effectiveness in scenarios where the risk of restenosis is higher.9 In this regard, all the subgroups analyzed in the SIRIUS and TAXUS studies10,11 show the unequivocal, uniform clinical benefit of using these stents. In addition, these stents appear to “neutralize” the detrimental effect of some clinical (e.g., diabetes mellitus) or anatomical conditions (long lesions, small vessels), with a comparably low failure rate, both among patients who present the adverse clinical condition and among those who do not (Table). Insulin-Dependent. Rapamycin-Resistant?