Long‐Term Outcomes after Drug‐Eluting Stent Implantation: Get Your Feet Wet in the Real‐World

Abstract

The Reality and The WorldThe term "real-world" was coined in the early 1960s and refers to the realm of practical or actual experience, as opposed to an abstract, theoretical, virtual, or idealized world. In our everyday "real-world" practice, we not so rarely feel a tugging between evidence from some (idealized?) randomized controlled trials (RCT) and the clinical application of their results to the specific patient that we have in front of us. That is what several of our colleagues named the difference between "evidence-based" and "patientbased" medicine. In the practice of interventional cardiology, this feeling is even more manifest regarding the "first-generation" drug-eluting stents (DES)-namely, sirolimus (SES)-and paclitaxel (PES)-eluting stents. Without any doubt, these first DES revolutionized the intervention world by making it possible to treat millions of people worldwide virtually perfectly. "Virtually perfectly" because, as noticed since the end of 2003, the reality of the extended use of DES wowed the actual vulnerable DES Achilles heel: an increased occurrence of device-mediated myocardial infarction due to late stent thrombosis. You all know this story well and we will not reiterate the details. However, one should realize that this true complication was rare enough that RCTs-even those performed in allAddress for reprints: Stephan Cook, Professor of Medicine and Head