Drug-eluting stents in primary percutaneous coronary intervention for ST-elevation myocardial infarction: an up-to-date review of the literature.
Drug-eluting stents (DES) have been approved by the Food and Drug Administration for percutaneous coronary intervention (PCI) in the treatment of stable coronary disease but not in the treatment of acute myocardial infarction. In the past, treatment of acute myocardial infarction was mainly done via thrombolysis and balloon angioplasty. Although the rates of stroke, reocclusion, and revascularization were improved with the advent of bare-metal stents, rates of restenosis remained high. Primary PCI for ST-elevation myocardial infarction has also evolved to include the use of DES in this setting. However, this "off-label" use has not been without concerns regarding safety. Stent thrombosis contributes to major morbidity and mortality after PCI. Suggestions of higher rates of stent thrombosis with the use of DES as compared to bare-metal stents have raised questions about DES safety and efficacy. The aim of the authors was to provide an in-depth review of the safety of DES in acute myocardial infarction. They have therefore reviewed the most up-to-date data, including observational studies, randomized trials, and meta-analyses on the use of DES in ST-elevation myocardial infarction. Overall, DES appear to have a similar safety profile as compared to bare-metal stents in primary PCI in the treatment of ST-elevation myocardial infarction. Nevertheless, large-scale randomized studies are needed to further evaluate the safety profile of drug-eluting stents as compared to bare-metal stents in this setting.
Adult Cardiac Catheterization Laboratory, UCLA Medical Center, Los Angeles, CA 90095-171715, USA.
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Ehdaie
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Lee
D015906:Angioplasty, Balloon, Coronary; D054855:Drug-Eluting Stents; D006801:Humans; D015201:Meta-Analysis as Topic; D009203:Myocardial Infarction / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic