Abstract
Drug-eluting stents have been a major advance in percutaneous coronary revascularization. Widespread use of these stents has been spurred by substantial reductions in restenosis rates when compared with bare metal stents. The use of drugeluting stents during ST-segment elevation myocardial infarction has been a common practice and is associated with lower revascularization rates in various studies. Unfortunately, significant concerns regarding the occurrence of late stent thrombosis with this technology persist. A clinical dilemma exists as to whether the benefits of reduced repeat revascularization with DES outweigh the harm caused by a possible increased occurrence of the infrequent but devastating complication of late stent thrombosis. This review with discuss the theoretical risks and benefits of DES for STEMI, the available data regarding their use, and the areas where future studies are needed.
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Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I, Detre K, Veltri L, Ricci D, Nobuyoshi M et al (1994) A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease Stent Restenosis Study Investigators. N Engl J Med 331(8):496–501
Kandzari DE, Roe MT, Ohman EM, Milford-Beland S, Chen AY, Lytle BL, Cohen DJ, Smith SC, Harrington RA, Gibler WB, Peterson ED (2005) Frequency, predictors, and outcomes of drug-eluting stent utilization in patients with high-risk non-ST-segment elevation acute coronary syndromes. Am J Cardiol 96(6):750–755
Lemos PA, Saia F, Hofma SH et al (2004) Short- and long-term clinical benefit of sirolimus-eluting stents compared to conventional bare stents for patients with acute myocardial infarction. J Am Coll Cardiol 43:704–708
Valgimigli M, Percoco G, Malagutti P, Campo G, Ferrari F, Barbieri D, Cicchitelli G, McFadden EP, Merlini F, Ansani L, Guardigli G, Bettini A, Parrinello G, Boersma E, Ferrari R (2005) STRATEGY Investigators Tirofiban and sirolimus-eluting stent vs abciximab and bare-metal stent for acute myocardial infarction: a randomized trial. JAMA 293(17):2109–2117
Spaulding C, Henry P, Teiger E, Beatt K, Bramucci E, Carrié D, Slama M, Merkely B, Erglis A, Margheri M, Varenne O, Cebrian A, Stoll H, Snead D (2006) Bode C for the TYPHOON investigators sirolimus-eluting versus uncoated stents in acute myocardial infarction. N Engl J Med 355:1093–1104
Laarman GJ, Suttorp MJ, Dirksen MT, Heerebeek L, Kiemeneij F, Slagboom T, van der Wieken L, Tijssen J, Rensing B, Patterson M (2006) Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. N Engl J Med 355:1105–1113
Wernick MH, Jeremias A, Carrozza JP (2006) Drug-eluting stents and stent thrombosis: A cause for concern? Coron Artery Dis 17(8):661–665
Stone GW, Ellis SG, Cox DA, Hermiller J, O’Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME (2004) TAXUS-IV Investigators A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350(3):221–231
Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C, Caputo RP, Kereiakes DJ, Williams DO, Teirstein PS, Jaeger JL, Kuntz RE (2003) SIRIUS investigators sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349(14):1315–1323
Neumann FJ, Kastrati A, Schmitt C, Blasini R, Hadamitzky M, Mehilli J, Gawaz M, Schleef M, Seyfarth M, Dirschinger J, Schomig A (2000) Effect of glycoprotein IIb/IIIa receptor blockade with abciximab on clinical and angiographic restenosis rate after the placement of coronary stents following acute myocardial infarction. J Am Coll Cardiol 35(4):915–921
Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, Brodie BR, Madonna O, Eijgelshoven M, Lansky AJ, O’Neill WW, Morice MC (2000) J Am Coll Cardiol 35(4):915–921. Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 341(26):1949–1956
Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Carroll JD, Rutherford BD, Lansky AJ (2002) Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Investigators Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med 346(13):957–966
Schwartz RS, Chronos NA, Virmani R (2004) Preclinical restenosis models and drug-eluting stents: still important, still much to learn. J Am Coll Cardiol 44(7):1373–1385
Waters RE, Kandzari DE, Phillips HR, Crawford LE, Sketch MH Jr (2005) Late thrombosis following treatment of in-stent restenosis with drug-eluting stents after discontinuation of antiplatelet therapy. Catheter Cardiovasc Interv 65(4):520–524
Kang WC, Han SH, Choi KR, Ahn TH, Shin EK (2005) Acute myocardial infarction caused by late stent thrombosis after deployment of a paclitaxel-eluting stent. J Invasive Cardiol 17(7):378–380
Ong AT, McFadden EP, Regar E, de Jaegere PP, van Domburg RT, Serruys PW (2005) Late angiographic stent thrombosis (LAST) events with drug-eluting stents. J Am Coll Cardiol 45(12):2088–2092
McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, Kinnaird T, Suddath WO, Weissman NJ, Torguson R, Kent KM, Pichard AD, Satler LF, Waksman R, Serruys PW (2004) Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 364(9444):1519–1521
Jeremias A, Sylvia B, Bridges J, Kirtane AJ, Bigelow B, Pinto DS, Ho KK, Cohen DJ, Garcia LA, Cutlip DE, Carrozza JP Jr (2004) Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation 109(16):1930–1932 Epub 2004 Apr 12
Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, Airoldi F, Chieffo A, Montorfano M, Carlino M, Michev I, Corvaja N, Briguori C, Gerckens U, Grube E (2005) Colombo A incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293(17):2126–2130
Pfisterer M, Brunner-La Rocca HP, Buser PT, Rickenbacher P, Hunziker P, Mueller C, Jeger R, Bader F, Osswald S, Kaiser C (2006) BASKET-LATE Investigators Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol 48(12):2584–2591 Epub 2006 Nov 2
Kaiser C, Brunner-La Rocca HP, Buser PT et al (2005) Incremental cost-effectiveness of drug-eluting stents compared with a third-generation bare-metal stent in a realworld setting: randomised Basel Stent Kosten Effektivitäts Trial (BASKET). Lancet 366:921–929
Wood S (2006) Studies linking drug-eluting stents to increased mortality/MI spark impassioned pleas for reason and calls for calm theheart.org. [HeartWire > Guidewire]; September 03, 2006. Accessed at http://www.theheart.org/article/736863.do on Dec 11, 2006
Wood S (2006) New meta-analyses, registry data stoke stent-thrombosis debate theheart.org. [HeartWire > Guidewire]; October 25, 2006. Accessed at http://www.theheart.org/article/749309.do on Dec 11, 2006
Bavry A, Kumbhani D, Helton T, Borek P, Mood G, Bhatt D (2006) Late Thrombosis of Drug-Eluting Stents: A Meta Analysis of Randomized Clinical Trials. Am J Med 119:1056–1061
Kastrati A, Mehilli J, Pache J, Kaiser C, Valgimigli M, Kelbak H, Menichelli M, Sabate M, Suttorp M, Baumgart D, Seyfarth M, Pfisterer M, Schomig A (2007) Analysis of 14 Trials Comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med [Epub ahead of print]
Mauri L, Hsieh WH, Massaro JM, Ho KK, D’Agostino R, Cutlip DE (2007) Stent thrombosis in randomized clinical trials of drug-eluting stents. N Engl J Med [Epub ahead of print]
Stone GW, Moses JW, Ellis SG, Schofer J, Dawkins KD, Morice MC, Colombo A, Schampaert E, Grube E, Kirtane AJ, Cutlip DE, Fahy M, Pocock SJ, Mehran R, Leon MB (2007) Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. N Engl J Med [Epub ahead of print]
Spaulding C, Daemen J, Boersma E, Cutlip DE, Serruys PW (2007) A pooled analysis of data comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med [Epub ahead of print]
Lagerqvist B, James SK, Stenestrand U, Lindback J, Nilsson T, Wallentin L (2007) Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med [Epub ahead of print]
Rinfret S, Grines CL, Cosgrove RS, Ho KK, Cox DA, Brodie BR, Morice MC, Stone GW, Cohen DJ (2001) Stent-PAMI investigators quality of life after balloon angioplasty or stenting for acute myocardial infarction one-year results from the stent-PAMI trial. J Am Coll Cardiol 38(6):1614–1621
Weintraub WS, Ghazzal ZM, Douglas JS Jr, Liberman HA, Morris DC, Cohen CL, King SB 3rd (1993) Long-term clinical follow-up in patients with angiographic restudy after successful angioplasty. Circulation 87(3):831–840
Babapulle MN, Joseph L, Belisle P, Brophy JM, Eisenberg MJ (2004) A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet 364(9434):583–591
Harmonizing outcomes with revascularization and stents in acute myocardial infarction. Accessed at http://www.clinicaltrials.gov/ct/show/NCT00433966?order=4 on February 19, 2007
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Ryan, J., Cutlip, D.E., Cohen, D.J. et al. Drug eluting stents for ST-elevation myocardial infarction: risk and benefit. J Thromb Thrombolysis 24, 293–299 (2007). https://doi.org/10.1007/s11239-007-0038-4
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DOI: https://doi.org/10.1007/s11239-007-0038-4