Real World' Comparison of Drug-Eluting Stents vs Bare Metal Stents in the Treatment of Unselected Patients With Acute ST-Segment Elevation Myocardial Infarction

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp rug-eluting stents (DES) have significantly reduced the need for repeat revascularization procedures after percutaneous coronary intervention (PCI) owing to decreased late luminal loss and angiographic restenosis. 1,2 Since their introduction, DES have rapidly substituted bare metal stents (BMS) in the treatment of various coronary artery lesions, including the treatment of ST-segment elevation myocardial infarction (STEMI).Primary angioplasty with coronary stenting has become the standard treatment for STEMI; 3 however, long-term data on the efficacy and safety of DES in this clinical setting are still limited. Due to the increased incidence of very late stent thrombosis (ST) and the need for prolonged dual antiplatelet therapy (DAT) after DES use, 4-8 questions have recently been raised regarding the long-term efficacy and safety of DES in the treatment of patients with acute STEMI.A few randomized prospective clinical trials have compared the outcome of DES vs BMS in patients with STEMI, 9-15 where sirolimus-eluting stents (SES) showed a decrease in the need for target vessel revascularization (TVR) in a study that mandated angiographic follow up, while paclitaxel-eluting stents (PES) did not show a significant benefit in a study that did not mandate angiographic follow up. In these studies, the incidence of ST did not differ between DES and BMS. However, the populations studied in these trials were selected patients, which limited its generalization to 'real-world'

Bare Metal Stent Thrombosis in Patients With Acute Coronary Syndrome

“…TYPHOON 20 was also a multicenter, prospectively randomized trial comparing sirolimus-eluting stents (n=355) with BMS (n=357) in primary PCI for STEMI; it demonstrated 1-year ST rates of 3.4% and 3.6%, respectively (P=1.00) in this selected population. Similar findings were reported by Park et al 21 These rates contrast with those from studies excluding STEMI patients and emergency PCI, such Tables 1,2. Tables 1,3.…”

Three-Year Follow-up of Sirolimus-Eluting Stents vs. Bare Metal Stents for Acute Myocardial Infarction

“…[19][20][21] In addition to the studies carried out in Western countries, Park et al showed that mid-to long-term outcomes were better in patients receiving DES for AMI in Korea. 22 In a 3-year follow up of the randomized DEDICATION trial, however, the rate of cardiac death was higher in the DES group compared to the BMS group. 23 Most, but not all of these studies have demonstrated the safety and efficacy of DES in patients with AMI.…”

Drug-Eluting Stents Are Not Indicated for Patients With Acute Coronary Syndrome - Should Drug-Eluting Stents Be Indicated for Patients With Acute Coronary Syndrome? (Con) -

“…36-38 However, there is a paucity of reports concerning longer-term prognosis of DES use in ACS. 39 Concerns exist regarding the long-term outcomes of DES vs BMS in patients with ACS in the real-world setting. A high frequency of VLST has been steadily observed in DES-implanted ACS patients.…”