In 1534 consecutive patients with STEMI treated by primary PCI, fifty patients with VLST were implanted with second-generation DES and 558 patients with de novo lesion were implanted with second-generation DES; baseline clinical characteristics with and without ST are listed in [Table 1].
This research was to evaluate the safety and effectiveness of primary PCI with second-generation DES for STEMI caused by VLST in real world.
There might be very few number of VLST cases, even thousands of patients would be randomized.
Our research proved that primary PCI with second-generation DES was an advisability management strategy for STEMI patients due to VLST. Several issues could be considered in more detail to explain the finding.
A Japanese study evaluated endothelial function after DES implantation, proved better endothelial function and greater endothelial coverage of ZES compared with paclitaxel eluting stent by acetylcholine infusion and OCT.[sup] Furthermore, a recent large meta-analysis including 9673 primary PCI patients for STEMI, second-generation DES appeared with significantly lower incidence of VLST, target vessel revascularization and MI compared with BMS at 3 years, and second-generation DES are safer, more effective and may be an available choice for primary PCI.[sup]
Although both SES and paclitaxel-eluting stents have greatly reduced in-stent restenosis, the first generation of DES has led to concern for increased risk of late and VLST due to delayed arterial healing.
Among the four cardiac death events, three of them were attributed to definite or probable late or VLST, although there were no significant differences between two groups.