Comparative Efficacy and Long-Term Outcomes of Drug-Eluting Stents vs. Bare-Metal Stents in Coronary Artery Disease: A Systematic Review.

Coronary artery disease (CAD) is a major global cause of morbidity and mortality, driving ongoing improvements in percutaneous coronary intervention (PCI). Drug-eluting stents (DES) have largely replaced bare-metal stents (BMS) due to superior performance in reducing restenosis and the need for repeat revascularization. This systematic review compares the efficacy and long-term safety of DES versus BMS in patients undergoing PCI. A total of 13 studies, including randomized controlled trials and observational studies, were included, covering diverse populations and follow-up periods ranging from 1 to 14 years. Primary outcomes assessed were all-cause mortality, major adverse cardiovascular events (MACE), myocardial infarction (MI), and target lesion revascularization (TLR). DES, particularly second-generation devices, were consistently associated with lower rates of MACE, MI, and TLR compared to BMS. Everolimus-eluting stents (EES) showed the most favorable safety profile regarding stent thrombosis. Secondary outcomes included in-stent restenosis (ISR) and bleeding risks. Notably, the benefits of DES were more pronounced in patients with diabetes and complex coronary anatomy. Some studies suggested gender-based differences favoring DES in women, though subgroup findings were exploratory and not always powered for statistical comparison. A few long-term studies observed a narrowing of the efficacy gap between DES and BMS beyond 10 years, though the clinical relevance of this remains limited. Overall, the findings support the continued use of DES as the preferred option in most PCI settings, with individualized decisions based on lesion complexity, comorbidities, and patient adherence to dual antiplatelet therapy. Continued innovation in stent design and long-term patient monitoring remains essential to optimizing CAD outcomes.