Can't Bare It Any Longer.

SEE PAGE 426 A gainst the background of comparative drugeluting stent (DES) trials, iterative stent designs, and even the advancement of bioresorbable scaffolding, studies demonstrating the clinical benefit of DES over conventional bare metal stents (BMS) seem a distant afterthought, and the clinical utility of BMS appears equally remote. Indeed, the prevalence of BMS use in economically developed countries approximates 10% of all percutaneous revascularization procedures, an estimate that continues to decrease annually over the past 5 years. Were it not for perceptions of safety with abbreviated dual antiplatelet therapy (DAPT) durations for BMS compared with DES, the use of BMS might even be lower; in many ways, therefore, treatment with BMS in itself conveys a “risk factor”— a coexisting condition that challenges DAPT adherence and confers increased risk, for example, excessive bleeding hazard, advanced age, impending need for noncardiac surgery, or even noncompliance. For these reasons, patients treated with BMS often demonstrate characteristics that routinely exclude them from representation in contemporary stent trials. The ZEUS (Zotarolimus-Eluting Endeavor sprint stent in Uncertain DES candidates) trial investigators tested the boundaries of abbreviated antiplatelet therapy and DES safety in such a patient population challenged by DAPT adherence (1). Among 1,606 randomized patients characterized as “uncertain DES candidates” based on thrombotic, bleeding, and restenosis risk features, and despite a median DAPT duration of only 32 days, the 1-year occurrence of