What are the 2014 ESC/EACTS and 2017 ESC guidelines regarding the use of drug-eluting stents (DES) in percutaneous coronary intervention (PCI) for the treatment of myocardial infarction (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Answer

In its 2014 update, the ESC/EACTS significantly diverged from its previous recommendations and those of ACC/AHA above. It recommends unrestricted use of new-generation DES, finding that previous concerns regarding the duration of DAPT, and the risks associated with DAPT cessation were unsubstantiated. [127]  Based on evidence of increased efficacy and safety, ESC/EACTS considers new-generation DES the default in all clinical conditions and lesion subsets where PCI is indicated. [127]

In the 2017 ESC guidelines, the recommendations for primary PCI reiterate that stenting is preferred over balloon angioplasty and that new-generation DES are preferred over baremetal stents (both class I, level of evidence: A). [70] In addition, if performed by an experienced radial operator, radial access is preferred over femoral access (class I, level of evidence: A).


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