Drug Eluting Stents (DES) In Patients With ST Elevation Myocardial Infarction (STEMI)

REVIEW, 7 October 2009, VOL I ISSUE I, ISSN 1756-0993
doi: 10.5083/ejcm.20424884.09 , Cite or Link Using DOI
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Kamal Chitkara, A.H. Gershlick

Use of drug-eluting stents (DES) in patients undergoing percutaneous coronary intervention (PCI) for STEMI appears from the published data to be safe and improves clinical outcomes by reducing the need for re-intervention compared with bare metal stents. Although DES effectively reduces restenosis, a small but significant number of patients suffer complications of in-stent thrombosis. Further, some clinicians maintain that in the acute presentation they know too little about the patient (need for future non-cardiac surgery, co-morbidities that will be influenced by the need for long term dual anti-platelet therapy (DAPT) that DES requires). We recommend that DES be used; however, unless there is obvious concerns regarding the use of longer term DAPT. The next generations of DES with better stent design, greater biocompatibility with release kinetics have shown promising results but larger randomised controlled studies are needed in patients with ACS and real world situations of patients with long lesions, calcification or bifurcations. As with all DES platforms, longer-term follow-up is required to assess their safety, especially in respect of very late stent thrombosis.

In conclusion, based on available data, implantation of DES with the caveats above can be recommended for patients undergoing PCI for STEMI.

Correspondence to:
Dr. K Chitkara, SpR Cardiology, Glenfield Hospital, Leicester, LE3 9QP. kamalchitkara@yahoo.co.uk

Keywords:

drug-eluting stents, st elevation myocardial infarction, percutaneous coronary intervention