New generation drug‐eluting stents for ST‐elevation myocardial infarction: A new paradigm for safety

Abstract

New generation DES in STEMI patients have less ST compared to BMS and trends for less ST compared to early generation DES. These data suggest a new safety paradigm and should encourage the use of new generation DES in most STEMI patients treated with primary percutaneous coronary intervention (PCI).

Long‐term outcomes following drug‐eluting stents versus bare metal stents for primary percutaneous coronary intervention: A real‐world analysis of 11,181 patients from the british columbia cardiac registry

“…When we used standard adjustment and propensity score methods we found that DES use was associated with a significant reduction in mortality. This would be in keeping with previously reported observational analyses demonstrating an early survival benefit with DES [15,17]. Interestingly, we found no association with DES use and TVR using standard adjustment and propensity score methods.…”

“…Observational studies have demonstrated significant early and late reductions in mortality with DES [14][15][16][17], which differs to randomized trial data [3,4,13]. In a nonrandomized setting, BMS may be given to the sicker patients who are poor candidates for prolonged dual antiplatelet therapy.…”

“…These factors may not be captured in the observational databases, and naturally induce severe selection bias. Observational analyses specifically comparing DES versus BMS in STEMI have found DES to be associated with early and late survival [15,17]. Interestingly, a significant difference in adjusted mortality was noted as early as 2 days [15].…”

“…Indeed, more than half of all DES implants are performed for "off-label" indications [12]. In the wider clinical population, both randomized trials [3,4,13] and observational studies [14][15][16][17] have demonstrated significant reductions in restenosis with DES use. However, data on mortality are strikingly disparate, with observational studies [14][15][16][17] demonstrating substantial reductions in mortality with DES.…”

Drug eluting stents in primary PCI: Ready for prime‐time?

“…In this week's issue of CCI , Garg et al report an analysis of 3,464 STEMI patients treated with PCI using BMS, early generation (PES and SES) DES or new generation (EES and ZES) DES, at one of two busy primary PCI centers. The patients were prospectively enrolled into a database over an 8‐year period, and the primary operator determined the choice of stent at the time of intervention.…”