The risks and benefits of drug-eluting stents in the setting of STEMI |
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Authors: | Rosetta Melfi Annunziata Nusca Giuseppe Patti Germano Di Sciascio |
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Institution: | (1) Department of Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy |
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Abstract: | Primary percutaneous coronary intervention (PCI) represents the treatment of choice in patients with ST-segment elevation
myocardial infarction (STEMI). In randomized trials excluding STEMI patients, using drug-eluting stents (DES) significantly
reduced angiographic restenosis and target vessel revascularization compared with bare metal stents (BMS); however, concerns
exist regarding an increased follow-up incidence of stent thrombosis after DES implantation. This complication, which is associated
with higher mortality and morbidity rates, may be more frequent among STEMI patients receiving DES versus BMS. Various registries,
randomized trials, and two recent meta-analyses on patients undergoing primary PCI have shown that using DES is safe and is
associated with significantly reduced rates of restenosis and repeat intervention without an increased risk of myocardial
infarction or stent thrombosis at intermediate-term follow-up. However, large trials with hard clinical end points and longer
follow-up are needed before routine DES use can be recommended in patients undergoing primary PCI. |
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