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Is there enough evidence for routine use of drug-eluting stents in acute myocardial infarction with ST segment elevation?

Primary percutaneous coronary intervention compared to the medical therapy is a method of choice in treating acute myocardial infarction with ST segment elevation (STEMI), significantly reducing mortality and recurrent ischemia. However, it is known that STEMI often carries the higher risk of stent thrombosis (ST), thus the place of drug eluting stent (DES) in the treatment of STEMI is still controversial, due to the lack of randomized studies with follow up of patients longer than one year. Efficacy of DES compared to bare metal stents (BMS) in terms of reduced in-stent restenosis and repeated intervention within a year was presented in several randomized trials, and meta-analysis. Although no significant difference in mortality, reinfarction and ST was shown in DES compared to BMS at one year of follow up, late safety issues with DES are mostly related to first-generation DES in patients with STEMI. Observational data, meta analysis and randomized trials with second generation DES devices have showed better efficacy with increased safety compared with either BMS or first generation of DES leading to the conclusion that second generation of DES should be the first choice in STEMI setting.