Experts debate merits of DES for acute MI

Drug-eluting stents (DES) for primary intervention in acute-MI patients appear to remain unpopular, although at least one expert believes the evidence favors them over bare-metal stents for this indication.

In a formal debate here at the European Society of Cardiology (ESC) 2010 Congress, Dr Manel Sabate (Hospital de Sant Pau, Barcelona, Spain) argued that DES should be used routinely for primary PCI. His opponent in the debate, Dr Gabriel Steg (Hôpital Bichat-Claude Bernard, Paris, France), argued that the evidence of additional risk of stent thrombosis with DES is not worth the benefit of reducing restenosis in this patient population.

By a show-of-hands poll, the cardiologists assembled to hear the debate showed they were skeptical of Sabate's position. Very few showed that they routinely use DES in AMI patients, and nobody raised their hand after the debate when asked whether the debate had changed their minds on the issue.

Sabate conceded that few AMI patients currently get DES in Europe. The Global Registry of Acute Coronary Events (GRACE) registry shows the proportion of DES in AMI is around 25%. For example, in Spain, DES represent about 60% of all coronary stents implanted but only between 20% and 25% of those used for AMI, Sabate said.