[The stent is only one tool in the treatment of STEMI].

The article published in this edition of the Journal, ‘‘Outcomes of drug-eluting stents compared to bare-metal stents in ST-segment elevation acute myocardial infarction’’ by Brito et al., is based on a registry of primary angioplasty between 2003 and 2007 in a high-volume Portuguese center. The aim of the study was to compare the clinical outcomes of patients presenting with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) using drug-eluting stents (DES) or bare-metal stents (BMS). Various points should be considered when comparing the clinical and angiographic performance of these stents in STEMI patients. One is the safety of DES in the context of thrombotic coronary occlusion. Most patients have total occlusion, which means not only a greater thrombotic burden but also greater difficulty in assessing the diameter of vessels that are often spastic and with TIMI flow <3, even after dilation. As pointed out by Brito et al., the safety of DES in such cases has been demonstrated in various registries and randomized trials. Another point is the poor performance of BMS compared to DES with regard to target-lesion revascularization (TLR) and target vessel revascularization (TVR). Based on angiographic evidence, even when the vessels are larger and the lesions are focal and are rarely calcified or diffuse, randomized trials have shown that sirolimusand paclitaxel-eluting stents are associated with less restenosis than BMS. The most interesting aspects of the article by Brito et al. are the analysis of the final outcome of primary PCI, as assessed by TIMI frame count, myocardial blush grade, peak troponin and ST-segment resolution, as well as the discussion of the clinical and angiographic differences