Percutaneous coronary intervention is often used for acute coronary syndrome (ACS). DES have been reported to result in fewer serious adverse events compared with bare-metal stents without increasing the risk of all-cause mortality or major cardiovascular events in ACS. A Cochrane review noted that the absolute risk of death was 6.97% in the DES group compared with 7.74% in the BMS group based on the risk ratio (RR) of 0.90 (95% confidence interval (CI) 0.78 to 1.03, 11,250 participants, 21 trials/22 comparisons). The absolute risk of a major cardiovascular event was 6.36% in the DES group compared with 6.63% in the BMS group based on the RR of 0.96 (95% CI 0.83 to 1.11, 10,939 participants, 19 trials/20 comparisons). Meta-analyses at maximum follow-up showed evidence of a benefit when comparing DES with BMS on the risk of a serious adverse event. The absolute risk of a serious adverse event was 18.04% in the DES group compared with 23.01% in the BMS group based on the RR of 0.80 (95% CI 0.74 to 0.86, 11,724 participants, 22 trials/23 comparisons), and Trial Sequential Analysis confirmed this result.

A recent observational study revealed significantly smaller thrombus burden with DES than with BMS at 1-month follow-up in STEMI cases. Second-generation DES are associated with a lower rate of acute and subacute stent thrombosis compared with BMS in the setting of ST-segment elevation myocardial infarction (STEMI).

The EXAMINATION (clinical Evaluation of the Xience-V stent in Acute Myocardial INfArcTION) trial also demonstrated a lower rate of definite stent thrombosis with an everolimus-eluting stent (EES) compared with the bare-metal stent (BMS).