title: Use of drug-eluting stents in acute myocardial infarction with persistent ST-segment elevation: results of the ALKK PCI-registry.
abstract: BACKGROUND
  Drug-eluting stents (DES) reduce the rate of in-stent restenosis (ISR) and target vessel revascularization significantly when compared with bare metal stents (BMS). Their beneficial effects have been demonstrated in patients with acute myocardial infarction also, but the use of DES in the latter population seems to be still limited in clinical practice.
  
  
  RESULTS
  From January 2006 to December 2011, 25,424 patients with ST-elevation myocardial infarction were enrolled in the German ALKK PCI-registry. In 5,467 patients (21.5 %), a DES was implanted in the culprit segment, in 16,911 patients (66.5 %) a BMS, and 2,959 patients (11.6 %) received neither DES nor BMS. The rates of DES for typical subgroups were 31.7 % in patients with diabetes, 36.6 % in unprotected left main stenosis, 32.4 % in ostial lesions, 32.0 % for a stent length >15 mm, 26.2 % for a stent diameter ≤3 mm, and 58.5 % for ISR. There was a wide range in the use of DES between the different ALKK hospitals with a minimum of 2.3 % and a maximum of 58.3 % for the total study period (median 22.0 %, quartiles 14.6 and 37.5 %).
  
  
  CONCLUSIONS
  Despite convincing data for the use of DES in patients with STEMI, there is still an underuse of DES in this clinical setting in Germany. This is particularly worrying for the subgroups of patients and lesions with a high risk of restenosis. Further efforts are needed to reduce the skepticism about DES and to improve guideline adherent treatment.
authors.affiliation: Klinikum Oldenburg, Klinik für Kardiologie, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany, t.haerle@gmx.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Härle
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Arne Kristian
authors.initials: AK
authors.lastname: Schwarz
authors.forename: Claus
authors.initials: C
authors.lastname: Lüers
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Harald
authors.initials: H
authors.lastname: Darius
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kasper
authors.forename: Karl Eugen
authors.initials: KE
authors.lastname: Hauptmann
authors.forename: Dietrich
authors.initials: D
authors.lastname: Andresen
authors.forename: Albrecht
authors.initials: A
authors.lastname: Elsässer
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000379:methods; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D008670:Metals