We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online


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.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence To Support The Update

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference