Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice; however, the final decisions concerning an individual patient must be made by the responsible health professional(s), in consultation with the patient and caregiver as appropriate.

Percutaneous coronary intervention is one of the most frequently performed therapeutic procedures in medicine. This review provides an overview of currently available devices, summarizes randomized evidence, and outlines clinical indications for use.

Background—: Early-generation drug-eluting stents releasing sirolimus (SES) or paclitaxel (PES) are associated with increased risk of very late stent thrombosis occurring >1 year after stent implantation. It is unknown whether the risk of very late stent thrombosis persists with newer-generation everolimus-eluting stents (EES). Methods and Results—: We assessed the risk of stent thrombosis in a cohort of 12 339 patients with unrestricted use of drug-eluting stents (3819 SES, 4308 PES, 4212 EES). Results are incidence rates per 100 person-years after inverse probability of treatment weighting to adjust for group differences. During follow-up of up to 4 years, the overall incidence rate of definite stent thrombosis was lower with EES (1.4 per 100 person-years) compared with SES (2.9; hazard ratio, 0.41; 95% confidence interval, 0.27–0.62; P <0.0001) and PES (4.4; hazard ratio, 0.33; 95% confidence interval, 0.23–0.48; P <0.0001). The incidence rate per 100 person-years of early (0–30 days), late (31 days–1 year), and very late stent thrombosis amounted to 0.6, 0.1, and 0.6 among EES-treated patients; 1.0, 0.3, and 1.6 among SES-treated patients; and 1.3, 0.7, and 2.4 among PES-treated patients. Differences in favor of EES were most pronounced beyond 1 year, with a hazard ratio of 0.33 (EES versus SES; P =0.006) and 0.34 (EES versus PES; P <0.0001). There was a lower risk of cardiac death or myocardial with EES compared with PES (hazard ratio, 0.65; 95% confidence interval, 0.56–0.75; P <0.0001), which was directly related to the lower risk of stent thrombosis–associated events (EES versus PES: hazard ratio, 0.36; 95% confidence interval, 0.23–0.57). Conclusion—: Current treatment with EES is associated with a lower risk of very late stent thrombosis compared with early-generation drug-eluting stents.