Stent selection in patients with acute coronary syndromes and unstable coronary lesions

Percutaneous coronary intervention (PCI) has been increasingly used over recent years during interventional procedures in patients with acute coronary syndromes including ST-elevation myocardial infarction (STEMI) and non-STEMI. In patients with either STEMI, non-STEMI, high-risk acute coronary syndromes with ECG changes or cardiac enzyme rises, PCI with bare-metal stent (BMS) implantation has been associated with a significant improvement in clinical outcome. Therefore, BMS implantation during primary PCI in STEMI has become a standard of practice. With the introduction of drug-eluting stents (DES) in this decade, the use of these new devices instead of BMS in patients with STEMI has emerged as a rational PCI alternative in this particular subgroup of patients. In spite of the unquestionable benefits of DES in terms of reduction of restenosis and rates of target vessel revascularization, specific concerns have arisen regarding their long-term safety. A high incidence of very late stent thrombosis has bee...