Drug-eluting stents for ST-elevation myocardial infarction: ready for prime time?

Primary percutaneus coronary intervention, performed in a timely manner, is currently the standard of care for patients with acute ST-elevation myocardial infarction (STEMI). Numerous clinical trials have shown the superiority of balloon angioplasty over thrombolytic therapy in decreasing the composite endpoint of death, reinfarction, and stroke in patients with STEMI [1]. Nonetheless, the efficacy of balloon angioplasty in the setting of STEMI is limited by the high risk of early reocclusion and late restenosis, providing the initial rationale for the development of coronary stents. Subsequent studies have confirmed that the implantation of bare-metal stents reduced the risk of reinfarction and target vessel revascularization compared with balloon angioplasty [2]. Bare-metal stents soon gave way to drug-eluting stents (DESs), which were first used in lower-risk, non-STEMI patient populations and were then rapidly adopted in STEMI interventions. However, the early enthusiasm for DESs subsided because of reports of very late stent thrombosis following their implantation, and the concern was especially serious for STEMI patients.