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DES vs BMS — EECC MCQ

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EasyCoronary Artery DiseaseDES vs BMSEECC

A 50-year-old man with stable angina asks about the role of drug-eluting stents (DES) versus bare-metal stents (BMS). Why have DES largely replaced BMS in contemporary practice?

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Correct answer: B — DES reduce in-stent restenosis from approximately 20-30% (BMS) to 5-10% by eluting antiproliferative drugs (everolimus, zotarolimus) that inhibit neointimal hyperplasia, without increasing stent thrombosis risk with contemporary thin-strut designs

First-generation DES (sirolimus, paclitaxel) reduced restenosis rates from ~20-30% (BMS) to ~5-10% but had concerns about very late stent thrombosis requiring prolonged DAPT. Contemporary thin-strut DES (2nd/3rd generation: everolimus-eluting, zotarolimus-eluting) have further reduced both restenosis and stent thrombosis rates, making them superior to BMS for virtually all PCI indications. The 2024 ESC CCS Guidelines recommend DES as the default stent for all PCI procedures (Class I, LOE A). BMS are no longer routinely used; their only niche was in patients perceived to need shorter DAPT (now achievable with DES using shortened DAPT strategies) or those with upcoming surgery. Current evidence supports DES even with 1-month DAPT if needed.

Reference: ESC (2024): CCS Guidelines