At the 2006 WCC/ESC meeting, the safety of DES was questioned and quickly became a hot issue in cardiovascular academia due to the reporting of several studies on late stent thrombosis and increased mortality with drug-eluting stents (DES). After more than 1 year of debate, reflection, and new research, the thinking about the safety of DES is becoming clearer, although the academic community has not yet reached a complete consensus. Safety issues of DES The safety issues of DES, specifically late/very late stent thrombosis may lead to an increased incidence of myocardial infarction (MI)/death. the OPTIMIST study is the largest series that has been collected on stent thrombosis, with a total of 12,281 stent placement patients, and the incidence of stent thrombosis was 0.85% for DES and 1.5% for bare metal stents (BMS) was 1.05%, P=0.24; the incidence of stent thrombosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency PCI was 3.6%; 67% of DES stent thrombosis was acute/subacute and 33% was late/very late, compared with 86% and 14% for BMS, respectively; very late stent thrombosis, stent thrombosis in The Rotterdam registry study reported an incidence of contrast-confirmed stent thrombosis of 1.3% per year and a 3-year cumulative incidence of 2.9% in patients with DES placement. Frustratingly, the occurrence of DES stent thrombosis does not disappear over time, with late stent thrombotic events remaining stable at 0.6% per year. Late stent thrombosis, despite its low incidence, is mostly a medical emergency, with 45% of such patients dying. Questions about the safety of DES have arisen primarily from the BASKET, BASKET-LATE, and SCAAR studies, as well as the Camenzind and Nordmann meta-analysis, and later the GRACE study, which largely disproved the safety of DES in direct PCI for STEMI. Certainly, all these studies consistently demonstrated that the incidence of target vessel revascularization (TVR) or target lesion revascularization (TLR) or restenosis was lower in the DES group than in the BMS group. The results of the BASKET clinical trial showed that only patients with bridge vessels and small vessel (<3 mm) lesions who opted for DES treatment had significantly lower rates of death, MI, and TVR than the BMS group; for other patients, such as those with larger diameter vessels, DES did not significantly benefit patients and was significantly more expensive than BMS. the BASKET-LATE study enrolled 746 patients in the BASKET trial who stopped taking clopidogrel 6 months after stent placement. Analysis of clinical outcomes from months 7 to 18 showed that the rate of combined cardiac death/MI was higher in the DES group than in the BMS group (4.9% vs. 1.3%, P = 0.03); late stent thrombosis was almost twice as common in the DES group as in the BMS group on angiography (1.4% vs. 0.8%), thrombosis-related clinical events were three times greater (2.4% vs. 0.8%), and 88% of cases presented with thrombosis-related clinical events (2.4% vs. 0.8%). ) and 88% of cases presented with MI or death; DES application was an independent predictor of late cardiac death/non-fatal MI.