The use of drug-eluting stents in ST-elevation myocardial infarction

Drug-eluting stents (DES) dramatically lower rates of restenosis in patients undergoing percutaneous coronary interventions. However, their use has extended beyond the initial approved indications into off-label scenarios such as ST-elevation myocardial infarction (STEMI). Multiple retrospective case series and 10 prospective randomised controlled trials have been published on the use of DES in STEMI patients, and these generally show reduced rates of target vessel revascularisation with a neutral effect on mortality. Three meta-analyses show similar findings with the composite endpoint of death, recurrent myocardial infarction, or re-intervention significantly lower in the DES group, although this was largely driven by a decrease in target vessel revascularisation. These studies also demonstrate that DES use in the setting of STEMI is not associated with increased risk of stent thrombosis compared to bare metal stents. In summary, current data support the efficacy of DES in reducing restenosis and re-intervention in patients who present with STEMI. From a safety standpoint, the use of DES in STEMI does not increase the risk of stent thrombosis, and there is no difference in overall mortality. The use of DES in STEMI patients should be individualised on a case-by-case basis given the importance of compliance with dual antiplatelet therapy.