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Safety and efficacy of first-generation and second-generation drug-eluting stents in the setting of acute coronary syndromes

Gorla, Riccardo; Loffi, Marco; Verna, Edoardo; Margonato, Alberto; Salerno-Uriarte, Jorge

Journal of Cardiovascular Medicine: July 2014 - Volume 15 - Issue 7 - p 532–542
doi: 10.2459/JCM.0b013e328365c0fc
Reviews: Interventional cardiology

Drug-eluting stents (DESs) are known to reduce in-stent restenosis rate, compared with bare metal stents (BMSs). Stent thrombosis, one of the most dangerous complications of DES, has emerged as a major concern. This issue has limited the use of DES in unstable coronary artery disease till recent years. In fact, acute coronary syndrome (ACS) and the subsequent activation of the hemocoagulative pathway could represent a prothrombotic environment, thus limiting the use of DES in this situation. Nowadays, there is increasing evidence in literature of similar stent thrombosis rates both for BMS and DES in ACS, and most interventional cardiologists are confident with the use of DES in ACS. The aim of this article is to review the current literature on this topic in order to compare first-generation and second-generation DES vs. BMS as concerns safety and efficacy.

aCardiology Clinic and University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese

bCardiology and Coronary Intensive Care Unit, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy

Correspondence to Riccardo Gorla, MD, PhD, Cardiology Clinic and University of Insubria, Ospedale di Circolo e Fondazione Macchi, viale Borri 57, 21100 Varese, Italy Tel: +39 0226437395; fax: +39 0293291315; e-mail:

Received 1 May, 2013

Revised 2 August, 2013

Accepted 4 August, 2013

© 2014 Italian Federation of Cardiology. All rights reserved.