BACKGROUND: Drug-eluting stents (DES) reduce the rate of in-stent restenosis (ISR) and target vessel revascularization significantly when compared with bare metal stents (BMS). Their beneficial effects have been demonstrated in patients with acute myocardial infarction also, but the use of DES in the latter population seems to be still limited in clinical practice. METHODS AND RESULTS: From January 2006 to December 2011, 25,424 patients with ST-elevation myocardial infarction were enrolled in the German ALKK PCI-registry. In 5,467 patients (21.5 %), a DES was implanted in the culprit segment, in 16,911 patients (66.5 %) a BMS, and 2,959 patients (11.6 %) received neither DES nor BMS. The rates of DES for typical subgroups were 31.7 % in patients with diabetes, 36.6 % in unprotected left main stenosis, 32.4 % in ostial lesions, 32.0 % for a stent length >15 mm, 26.2 % for a stent diameter ≤3 mm, and 58.5 % for ISR. There was a wide range in the use of DES between the different ALKK hospitals with a minimum of 2.3 % and a maximum of 58.3 % for the total study period (median 22.0 %, quartiles 14.6 and 37.5 %). CONCLUSIONS: Despite convincing data for the use of DES in patients with STEMI, there is still an underuse of DES in this clinical setting in Germany. This is particularly worrying for the subgroups of patients and lesions with a high risk of restenosis. Further efforts are needed to reduce the skepticism about DES and to improve guideline adherent treatment.
BACKGROUND: Drug-eluting stents (DES) reduce the rate of in-stent restenosis (ISR) and target vessel revascularization significantly when compared with bare metal stents (BMS). Their beneficial effects have been demonstrated in patients with acute myocardial infarction also, but the use of DES in the latter population seems to be still limited in clinical practice. METHODS AND RESULTS: From January 2006 to December 2011, 25,424 patients with ST-elevation myocardial infarction were enrolled in the German ALKK PCI-registry. In 5,467 patients (21.5 %), a DES was implanted in the culprit segment, in 16,911 patients (66.5 %) a BMS, and 2,959 patients (11.6 %) received neither DES nor BMS. The rates of DES for typical subgroups were 31.7 % in patients with diabetes, 36.6 % in unprotected left main stenosis, 32.4 % in ostial lesions, 32.0 % for a stent length >15 mm, 26.2 % for a stent diameter ≤3 mm, and 58.5 % for ISR. There was a wide range in the use of DES between the different ALKK hospitals with a minimum of 2.3 % and a maximum of 58.3 % for the total study period (median 22.0 %, quartiles 14.6 and 37.5 %). CONCLUSIONS: Despite convincing data for the use of DES in patients with STEMI, there is still an underuse of DES in this clinical setting in Germany. This is particularly worrying for the subgroups of patients and lesions with a high risk of restenosis. Further efforts are needed to reduce the skepticism about DES and to improve guideline adherent treatment.
Authors: Bindu Kalesan; Thomas Pilgrim; Katja Heinimann; Lorenz Räber; Giulio G Stefanini; Marco Valgimigli; Bruno R da Costa; François Mach; Thomas F Lüscher; Bernhard Meier; Stephan Windecker; Peter Jüni Journal: Eur Heart J Date: 2012-02-23 Impact factor: 29.983
Authors: Christian Spaulding; Patrick Henry; Emmanuel Teiger; Kevin Beatt; Ezio Bramucci; Didier Carrié; Michel S Slama; Bela Merkely; Andrejs Erglis; Massimo Margheri; Olivier Varenne; Ana Cebrian; Hans-Peter Stoll; David B Snead; Christoph Bode Journal: N Engl J Med Date: 2006-09-14 Impact factor: 91.245
Authors: Gerrit J Laarman; Maarten J Suttorp; Maurits T Dirksen; Loek van Heerebeek; Ferdinand Kiemeneij; Ton Slagboom; L Ron van der Wieken; Jan G P Tijssen; Benno J Rensing; Mark Patterson Journal: N Engl J Med Date: 2006-09-14 Impact factor: 91.245
Authors: Antoinette de Waha; Salvatore Cassese; Duk-Woo Park; Francesco Burzotta; Robert A Byrne; Tomohisa Tada; Lamin A King; Seung-Jung Park; Albert Schömig; Adnan Kastrati Journal: Clin Res Cardiol Date: 2012-03-16 Impact factor: 5.460
Authors: Gregg W Stone; Ali Rizvi; William Newman; Kourosh Mastali; John C Wang; Ronald Caputo; Julie Doostzadeh; Sherry Cao; Charles A Simonton; Krishnankutty Sudhir; Alexandra J Lansky; Donald E Cutlip; Dean J Kereiakes Journal: N Engl J Med Date: 2010-05-06 Impact factor: 91.245
Authors: Jasper Boeddinghaus; Tobias Reichlin; Thomas Nestelberger; Raphael Twerenbold; Yvette Meili; Karin Wildi; Petra Hillinger; Maria Rubini Giménez; Janosch Cupa; Lukas Schumacher; Marie Schubera; Patrick Badertscher; Sydney Corbière; Karin Grimm; Christian Puelacher; Zaid Sabti; Dayana Flores Widmer; Nicolas Schaerli; Nikola Kozhuharov; Samyut Shrestha; Tobias Bürge; Patrick Mächler; Michael Büchi; Katharina Rentsch; Òscar Miró; Beatriz López; F Javier Martin-Sanchez; Esther Rodriguez-Adrada; Beata Morawiec; Damian Kawecki; Eva Ganovská; Jiri Parenica; Jens Lohrmann; Andreas Buser; Dagmar I Keller; Stefan Osswald; Christian Mueller Journal: Clin Res Cardiol Date: 2017-02-01 Impact factor: 5.460
Authors: Anna Franzone; Dik Heg; Lorenz Räber; Marco Valgimigli; Raffaele Piccolo; Thomas Zanchin; Kyohei Yamaji; Stefan Stortecky; Stefan Blöchlinger; Lukas Hunziker; Fabien Praz; Peter Jüni; Stephan Windecker; Thomas Pilgrim Journal: Clin Res Cardiol Date: 2016-04-01 Impact factor: 5.460