Current status of percutaneous coronary intervention with drug-eluting stents in Asia.

In the last 3 decades, there has been a revolutionary change in the treatment of coronary artery disease. Through advances in equipment and technical skills, percutaneous coronary intervention (PCI) is being applied to increasingly more complex patients and lesions. In particular, coronary stenting has emerged as an effective strategy to prevent recurrence after PCI. However, restenosis in the stented segment remained a major issue in coronary stenting.1 The recent introduction of drug-eluting stents (DES) has dramatically reduced restenosis rates compared with bare metal stent (BMS) use. Large randomized clinical trials have confirmed the benefits of DES over BMS in terms of decreasing the incidence of in-stent restenosis and the need for repeat revascularization.2–4 As a result, there has been a very rapid worldwide shift in the treatment of coronary stenosis from BMS to DES, including in most Asian countries. However, concern remains over late-occurring stent thrombosis after DES implantation.5–7 The prevalence of coronary artery disease has increased considerably in Asian countries over the past several decades as a result of shifts toward a more “westernized” lifestyle. Accordingly, PCI with stents is a common procedure in Asia, with 300 000 cases performed each year.8,9 The present article describes the current status of DES use in Asian countries using both published and unpublished data. A few randomized studies have been performed in Asian countries, allowing the examination of pertinent registries to explore issues relating to DES in Asian countries. However, this review article cannot cover the disparities of patient demographics, practice pattern, and outcomes in all the different Asian countries because of a striking lack of published data. In addition, within the scope of the current review, the majority of data may reflect the performance of advanced centers in which PCI is practiced by experienced operators.