Pieter C. Smits CIT 2010 Interview
<International Circulation>: In the treatment of ACS and AMI， does the selection of a specific DES matter in clinical outcomes?
Prof. Smits: I certainly believe that it matters. I have the firm belief that there are differences between drug-eluting stents. This is true especially when you look at the first generation compared to the second generation. You cannot generalize all drug-eluting stents.
<International Circulation>: What do you think is the major factor when considering selection of DES or BMS for patients with AMI?
Prof. Smits: This is a very serious and important topic. Stent thrombosis is enhanced in acute coronary syndrome so your stent selection should be focused on the specific problem of stent thrombosis. In that regard， I think that bare-metal stents have an advantage compared to certain drug-eluting stents. However， I do believe that certain drug-eluting stents are comparable and potentially even better in preventing stent thrombosis in patients who present with AMI.
<International Circulation>: Is there any new trial data comparing outcomes between DES and BMS in patients with AMI?
Prof. Smits: Yes， it is a very active field and I know that a few trials are ongoing and will probably present data soon， including at EuroPCR. One trial that we collaborated on compared the Xience V stent with the Cypher stent in AMI patients and I assume that the preliminary data will be presented at the EuroPCR meeting.
<International Circulation>: The 2009 updated ACC/AHA Guidelines for the Management of Patients with STEMI and the ACC/AHA/SCAI Guidelines for PCI preferred DES to BMS for patients undergoing emergent PCI (class IIa/level B). Can you comment on this recommendation? Also， what do you think about the role of BMS in the future; will they be replaced completely by DES?
Prof. Smits: This recommendation is quite new and this class IIa/level B， which means that you can contemplate using drug-eluting stents in a STEMI patient. As usual， there is a short time lag between the guidelines and current clinical practice， but I think they are correct. There is no hard indication yet to place a DES in all STEMI patients. I would like to emphasize that you can’t generalize all drug-eluting stents and there are going to be some differences between different drug-eluting stents in STEMI patients. I personally believe that DES will replace BMS， although on economic grounds there may still be a place for bare-metal stents in a certain subset of patients.
<International Circulation>: The COMPARE trial was recently published and we would like to know what you think that we have learned from this all-comers trial?
Prof. Smits: As you mentioned， it is an all-comers trial and it reflects real world conditions， which is important for clinicians， and it showed that we now have a drug-eluting stent available that has not improved safety but also efficacy. This is the first time in a drug-eluting stent trial where it was shown that we can improve both safety and efficacy.
<International Circulation>: What is the significance of the COMPARE trial versus other trials studying the Xience V stent?
Prof. Smits: The all-comers concept， which is a real world situation， in comparison to the randomized control trials like SPIRIT II/III/IV trials that had restrictive exclusion criteria. In this case all patients that were eligible for PCI and came to the centers were included and the results reflected those specific patients. What I would like to stress is that in the COMPARE trial 60% of our patients presented with ACS and it is common now that a majority of our patients that we treat with PCI are admitted with and acute coronary syndrome and this specific subset of patients are often excluded from randomized control trials.
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