Key result
DES reduces TVR vs BMS in STEMI without increasing death or recurrent MI.
Why the study?
Patients with STEMI were excluded from many trials establishing DES safety and efficacy, and concerns remain about stent thrombosis risk and long-term outcomes in this high-risk group.
Do drug-eluting stents improve safety and efficacy compared to bare metal stents in patients with ST-elevation myocardial infarction?
Do drug-eluting stents improve safety and efficacy compared to bare metal stents in patients with ST-elevation myocardial infarction?
This review summarizes the available evidence comparing drug-eluting stents to bare metal stents in STEMI patients, addressing concerns about late stent thrombosis and long-term efficacy.
Supports preferring drug-eluting stents in STEMI to reduce revascularization; leaves open need for updated randomized long-term safety data.
Drug-eluting stents (DES) reduce restenosis and the need for repeat revascularization, but patients with ST-segment elevation myocardial infarction (STEMI) were excluded from many of the trials that established the safety and efficacy of DES. Because of the unstable nature of lesions associated with STEMI, these patients are considered high risk, and often experience higher rates of adverse events. There is concern that DES may increase the risk of stent thrombosis, particularly late and very late stent thrombosis, in STEMI patients. Evidence also suggests that although DES reduce target vessel revascularization, this benefit may be lost after extended follow-up due to procedures necessitated by increased stent thrombosis. Several randomized trials, meta-analyses, and registry studies have been conducted to compare DES with bare metal stents in patients with STEMI, but many of the studies are not large scale and the length of follow-up has been limited in duration. This review summarizes the data comparing DES with bare metal stents in patients with STEMI.
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Beattie et al. (2010) conducted a review in ST-Elevation Myocardial Infarction. Drug-eluting stents vs. Bare metal stents was evaluated on Target vessel revascularization and safety endpoints (stent thrombosis, recurrent MI, death). Drug-eluting stents reduce target vessel revascularization compared to bare metal stents in patients with ST-elevation myocardial infarction, without significantly increasing the risk of death or recurrent myocardial infarction.
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