[Which should be indicated for patients with ACS, DES or BMS?]
1Department of Cardiology, Tenri Hospital.
Insights
Drug-eluting stents (DES) may reduce repeat procedures for ST-elevation myocardial infarction (STEMI) without increasing major adverse events. However, long-term safety and benefits in preventing death or recurrent heart attacks require further investigation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Context:
- ST-elevation myocardial infarction (STEMI) is a critical form of acute coronary syndrome.
- The role of drug-eluting stents (DES) versus bare-metal stents (BMS) in STEMI management remains under evaluation.
- Existing evidence is derived from registry, randomized, and meta-analysis studies.
Purpose:
- To review and synthesize current evidence on the effectiveness and safety of DES in STEMI treatment.
- To assess the impact of DES on restenosis, repeat revascularization, mortality, myocardial infarction, and stent thrombosis.
- To identify gaps in knowledge regarding long-term outcomes and safety concerns.
Summary:
- DES demonstrate a trend towards reduced repeat revascularization in STEMI patients compared to BMS.
- No randomized trials have conclusively shown DES reduce death or recurrent myocardial infarction in STEMI.
- Long-term safety data for DES in STEMI are insufficient to eliminate concerns, though no clear safety issues have emerged.
Impact:
- Findings suggest DES may offer short-term benefits in reducing restenosis and repeat procedures for STEMI.
- Highlights the need for further robust, long-term studies to confirm safety and efficacy in preventing major adverse cardiovascular events.
- Informs clinical decision-making regarding stent selection for STEMI patients, balancing short-term procedural benefits with long-term uncertainties.
Abstract:
The effectiveness of the use of drug-eluting stent (DES) in the treatment of ST-elevation myocardial infarction (STEMI), a representative condition of acute coronary syndrome, is still unknown. In this article, data of registry, randomized, and meta-analyses studies were reviewed. DES showed a consistent trend toward decreasing the risk of repeat revascularization without increasing the incidence of death, recurrent myocardial infarction, and stent thrombosis as compared to BMS. The findings concerning the use of DES in patients with STEMI are that; (1) its short-term effect of reducing the restenosis and repeat revascularization rates is evident; (2) no randomized studies have demonstrated the usefulness of DES in the prevention of death and recurrent myocardial infarction; (3) no randomized or meta-analyses studies have shown results sufficient to eliminate long-term safety concerns; and most importantly, (4) there are no data clearly indicating safety concerns.
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