[Is acute myocardial infarction an appropriate setting for drug-eluting stents?].

Drug-eluting stents (DESs) represent the most important advance in interventional cardiology in the last 15 years.1 These devices have altered the outcomes of patients undergoing percutaneous coronary interventions (PCIs) by drastically reducing the recurrence of angina and the need for repeat revascularization procedures.2 Despite the limitations that are still present with this type of stent (higher cost, need for twice as much antiplatelet therapy for longer, and a slight increase in the incidence of stent thrombosis from the first year of implantation), the obvious clinical advantages that they offer has meant that they are implanted in 2 out of every 3 patients undergoing PCI in Spain, a figure similar to the rest of Europe.3 Primary angioplasty is the treatment of choice for STelevation acute myocardial infarction (STEMI), and so the number of PCIs performed in such patients has increased year after year.3,4 In view of the large thrombotic component of lesions, STEMI is often one of the settings in which the use of new devices is most controversial, and so they were incorporated later into clinical practice. In the case of bare-metal stents, the most important concern was the possibility of a high risk of stent thrombosis, but randomized studies showed that treatment of STEMI through systematic stent implantation clearly reduced the need for repeat revascularization procedures in the target vessel.5 Although no benefit was observed in terms of infarction size, mortality, or the risk of reinfarction compared to balloon angioplasty alone, the decrease in the rate of repeat revascularizations was largely responsible for ensuring that patients with STEMI undergoing PCI usually also underwent stent placement. Even with the use of stents, one of the most important limitations of primary angioplasty in the medium and Is Acute Myocardial Infarction an Appropriate Setting for Drug-Eluting Stents?