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Editor's Correspondence |

Drug-Eluting Stents Should Not Be Used in ST-Elevated Myocardial Infarction With Cardiogenic Shock

Sébastien Champion, MD; Bernard Alex Gaüzère, MD; Yannick Lefor, MD
Arch Intern Med. 2012;172(20):1613-1614. doi:10.1001/archinternmed.2012.4418.
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De Luca and colleagues1 concluded from their meta-analysis that drug-eluting stents (DES) in the ST-elevated myocardial infarction (STEMI) setting are more efficient than bare-metal stents (BMS) in reducing target-vessel revascularization (TVR). One must remember that during STEMI, one of the most serious complications is cardiogenic shock, which is not well pinpointed in their study.

We would like to share our experience in our intensive care unit in which 249 patients presenting with a cardiogenic shock were retrospectively reviewed during 2 years. Of the 249 patients, 51 underwent a coronary stenting: 30 (59%) ended up with at least 1 DES and 21 (41%) with only a BMS. The choice of the device was made by the coronarographist, according to the French guidelines.2 Despite an aggressive support (78% had a counterpulsation, 43% an hemodialysis, and 10% an assist device), the mortality remained high, even with a trend in higher mortality in the DES group (53% vs 47%; P = .16). Even used on a liberal basis in patients with similar risk markers (ie, age, left ventricular ejection fraction, Simplified Acute Physiology Score [SAPSII] score3), the DES did not reduce that tremendous mortality rate. Major hemorrhages were diagnosed in 59% of the patient with a median of 3 packed red blood cells transfused. Antiplatelet therapy had to be stopped for a few days in nearly half of patients.

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