Acute Myocardial Infarction – The Role of Drug-eluting Stents in Treatment Strategies

Abstract

Although primary percutaneous coronary intervention (PCI) has become the cornerstone in the treatment of ST-segment elevation acute myocardial infarction (AMI), systemic fribrinolysis may still be considered for patients in areas where PCI is not accessible. The downside of initial plain balloon angioplasty, mainly coronary artery dissection and vessel re-occlusion, was effectively solved by the application of coronary stents. The incidence of target vessel failure, witnessed after bare metal stent (BMS) implantation, was dramatically reduced by the introduction of drug-eluting stents (DES), which significantly and effectively alleviate restenosis in the overall population. A minute incidence of late and very late DES thrombosis led to some safety concerns, which were soon rebutted, particularly by the development of newer generation DES. DES have consequently outplayed BMS among almost all anatomical and clinical subgroups of coronary artery disease patients. However, AMI remains one of the last contested territories. Today there is a growing body of evidence to support the use of DES as a safe and effective treatment of AMI.