Myocardial revascularization with drug-eluting coronary artery stents: the clinical impact of technological progress

The objective of the scientific work presented in this PhD Thesis is to investigate the clinical impact of drug-eluting stents technological progress on clinical outcomes in patients with coronary artery disease. The first section of this Thesis includes two review articles providing an extensive overview on coronary artery stent technology. The second section of this Thesis evaluates the impact on clinical outcomes of new generation drug-eluting stents in a wide spectrum of patients. This section comprises a number of original investigations – including a randomized clinical trial, a large-scale multicenter registry, a pooled analysis of individual patient data from 26 randomized trials, and a network meta-analysis of 100 randomized trials. The third section of this Thesis investigates the safety and efficacy profile of drug-eluting stents with biodegradable polymer coatings – a specific type of new generation drug-eluting stents. In the context of the present Thesis, drug-eluting stents with biodegradable polymer coating were evaluated in a randomized clinical trial during long-term follow-up and in a large pooled analysis of individual patient data from 3 randomized trials. The fourth section of the present Thesis focuses on clinical outcomes of drugeluting stents in high-risk patient populations. Several original investigations are presented in this section exploring the impact on drug-eluting stents safety and efficacy of clinical and anatomical complexity of coronary artery disease, genderdifferences, renal impairment, acute coronary syndromes, acute myocardial infarction, and diabetes mellitus. Finally, the fifth and last section provides summary and conclusions of the presented scientific work.