Drug eluting cardiac stents fail for different reasons and in different settings. More are expected to fail when used in complex lesions than in simple lesions, and each type of device will have different failure rates at different points along any one complexity scale. Head to head trial data from different countries in complex settings also show how differently two devices may perform. Future trials should examine why these differences exist, not just compare one device with another (Circulation 2006; 113: 2262-5).

Another discussion about drug eluting stents appears in the Journal of Thoracic and Cardiovascular Surgery (2006;131: 956-62). Coronary revascularisation that integrates stenting with minimally invasive surgical anastomosis is feasible and seems safe. A study that combined stents implanted to lesions in the non-left anterior descending coronary artery and anastomosis of the left internal thoracic artery to the left anterior descending coronary artery resulted in no complications in the first 90 days. At seven months no one required repeat coronary artery bypass grafting.

Crack cocaine use is a problem now in rural areas (Journal of Public Health 28 April 2006, doi;10.1093/pubmed/fd1010). A survey in one English rural county found that 31% of drug users in treatment services are moderately or …