The use of drug-eluting stents in acute myocardial infarction – is the battle coming to an end? From despair to acceptance

Abstract

The large-scale use of drug-eluting stents (DES) in elective percutaneous coronary interventions resulted in a significant reduction of restenosis and the need for repeat revascularization, compared to bare-metal stents (BMS) and balloon angioplasty. The position of DES used during primary percutaneous coronary intervention was not so well established. Based on the trials including the general population of patients, an increased risk of stent thrombosis was indicated, particularly late after implantation, which may be associated with increased mortality. A number of randomized clinical trials have compared first generation DES with BMS in acute ST-segment elevation myocardial infarction (STEMI). In most of them increased mortality after DES implantation was not confirmed, with demonstrated reduction of repeat revascularizations. However, long-term follow-up of these studies and the results from non-randomized “real world” registries are equivocal. A new generation of DES has been present on the market for several years. They have modern designs, are covered with more neutral polymers and release new drugs. The new generation DES have a better safety and efficacy profile, including a population of patients with acute STEMI, than the first generation stents. This paper is a review of randomized controlled trials, meta-analyses and registries, comparing DES with BMS in patients with acute STEMI. Attention was drawn to the current position and the role of new generation DES, which may prove to be a safe and effective choice in this population of patients.

Hybrid coronary revascularization versus coronary artery bypass grafting for multivessel coronary artery disease: systematic review and meta-analysis

“…Conversely, CABG is a relatively aggressive surgical procedure with a higher risk of postoperative stroke [ 1 , 3 - 5 ], and conduits via the saphenous vein graft have comparatively short-term patency [ 6 , 7 ]. In contrast, percutaneous coronary intervention, a much less invasive method, carries a minimal procedural risk as well as a lower prevalence of failure for the target vessel due to the use of drug-eluting stents (DES) [ 8 , 9 ]. However, those benefits come at the expense of the need for repeat revascularization [ 2 ].…”

Acute two-vessel occlusion due to simultaneous very late stent thrombosis following sirolimus-eluting stent implantation: a case report and review of the literature

“…The incidence of VLST appears to be between 0.4% and 0.6% per year in the literature [ 5 ], which can lead to high mortality [ 6 ]. The mechanism is not fully understood.…”

Comparative analysis of hybrid myocardial revascularization and multivascular percutaneous coronary interventions in patients with stable coronary artery disease and multivascular coronary disease. 30-day results

“…Напротив, чрескожное коронарное вмешательство (ЧКВ) -менее травматичная процедура и имеет низкий риск развития периоперационных осложнений. Однако ЧКВ ПНА уступает маммарокоронарному шунтированию (МКШ) по частоте повторной реваскуляризации, несмотря на использование стентов с лекарственным покрытием [10].…”