While drug-eluting stents reduce restenosis in STEMI, careful patient selection is necessary due to the risk of late stent thrombosis and the requirement for prolonged dual antiplatelet therapy.
Requires individualized DAPT decisions after DES in AMI; leaves open optimal duration and mitigation strategies.
Primary percutaneous coronary intervention is the preferred reperfusion therapy for ST-segment elevation acute myocardial infarction patients within 12 hours of symptom-onset. Routine stent implantation during the procedure significantly reduces the rate of target vessel revascularization, although restenosis still represents a current limitation of the technique. Drug-eluting stents were developed to treat and prevent coronary restenosis. Randomized trials, meta-analysis, and registries proved their efficacy and safety in different clinical situations, including acute myocardial infarction. However, the increased risk of late stent thrombosis associated with drug-eluting stents during primary percutaneous coronary interventions encourages a careful analysis to identify which patients most benefit from them, as well as those where a prolonged dual antiplatelet therapy does not represent a limiting factor.
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Andrade et al. (2011) studied this question.
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