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Chapter 1

The Thrombotic AMI Lesion: Lessons from Pathology more...

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Electrocardiographic Identification of the Culprit Lesion in ST-Segment Elevation Myocardial more...

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The Role of Thrombolysis in the Era of STEMI Interventions more...

Chapter 4

STEMI Interventions: A Review of Relevant Clinical Trials more...

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Updated Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction more...

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Chapter 8
Stents in STEMI Intervention
Vinod Jorapur, MD

Introduction and General Concepts
The primary objective of treatment of acute ST-segment elevation myocardial infarction (STEMI) is myocardial salvage resulting from prompt restoration of flow in the infarct-related artery (IRA). This is best accomplished by primary percutaneous coronary intervention (PCI). The secondary objective of maintaining long-term patency of the IRA is facilitated by stent implantation. While the focus of STEMI intervention has been restoring epicardial flow, the critical importance of microvascular perfusion for myocardial salvage is being better appreciated. The mechanistic underpinnings and the technical aspects of stent implantation impacting the achievement of these objectives of STEMI intervention are discussed here. The interacting role of stent implantation with the emerging modality of thrombus aspiration is explored. In patient populations excluding STEMI, drug-eluting stents (DES) have been shown to be superior to bare-metal stents (BMS) in terms of lower rates of restenosis and lower requirement for repeat revascularization. Maintaining target vessel patency may be all the more important after STEMI intervention, as this may improve left ventricular function recovery and prevent reinfarction, leading to better clinical outcomes. However, there has been a valid concern about increased risk of stent thrombosis (ST) in patients with STEMI, which may potentially offset the advantages of DES. This calls for a careful reappraisal of the rationale for and a critical review of the accumulating data on the safety and efficacy of DES in the setting of STEMI.

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