Targeted stent use in clinical practice based on evidence from the BAsel Stent Cost Effectiveness Trial (BASKET)

Pfisterer, Matthias; Kaiser, Christoph; Brunner‐LaRocca, Hans‐Peter

doi:10.1093/eurheartj/ehl490

Cited by 70 publications

(16 citation statements)

References 34 publications

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“…In a previous analysis of the same dataset, both SVG and vessel size were identified as predictors of late outcome [29]. The present study serves as an exploratory analysis of this finding investigating baseline and outcome differences between SVG and similarly sized native vessels treated with different stent types including all patients with a PCI using a stent ≥3 mm in diameter; however, it was allowed to post-dilate 3.5-mm stents up to 4.0 mm, if necessary.…”

Section: Methodsmentioning

confidence: 99%

“…Specifically, the RRISC (Reduction of Restenosis in Saphenous Vein Grafts with Cypher Sirolimus-Eluting Stents) study demonstrated conflicting results with DES reducing late loss after 6 months [26] but exposing to a long-term hazard with increased all-cause mortality after 3 years [27]. In contrast, a previous exploratory analysis of BASKET (Basel Stent Kosten Effektivitäts Trial/Basel Stent Cost Effectiveness Trial) [28] demonstrated that SVG lesions carried a high risk of recurrent clinical events which could be reduced by the use of DES, but specific results were lacking [29]. …”

Section: Introductionmentioning

confidence: 99%

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Drug-Eluting Stents Compared with Bare Metal Stents Improve Late Outcome after Saphenous Vein Graft but Not after Large Native Vessel Interventions

et al. 2008

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Objectives: To define long-term efficacy of different stent types in saphenous vein graft (SVG) interventions. Methods: In BASKET (Basel Stent Cost Effectiveness Trial), major adverse cardiac events (MACE), i.e. cardiac death, myocardial infarction and symptom-driven target vessel revascularization (TVR) were assessed after 18 months comparing drug-eluting stents (DES) versus bare metal stents (BMS), and SVG and large native vessels (≧3.0 mm). Results: Large vessel interventions were performed in 605 patients. Patients with SVG interventions (n = 47, 8%) were older and had more often hypertension, prior myocardial infarction, prior revascularization and multivessel disease and less frequent ST-elevation myocardial infarction than patients with large native vessel interventions (n = 558, 92%). Stent number and length were higher in SVG than in large native vessel interventions. Baseline characteristics were similar for DES and BMS. In SVG stenting, long-term outcome was better in DES- than in BMS-treated patients (MACE 21 vs. 62%, p = 0.007, mainly due to TVR 18 vs. 46%, p = 0.045), but for large native vessel stenting, no significant difference was noted (MACE: 13 vs. 16%, p = 0.40). Conclusions: Among patients with SVG disease, treatment with DES resulted in a better long-term outcome than treatment with BMS. In contrast, no DES benefit was found in similarly sized native vessels regarding MACE.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Drug-Eluting Stents Compared with Bare Metal Stents Improve Late Outcome after Saphenous Vein Graft but Not after Large Native Vessel Interventions

et al. 2008

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“…79 Similarly, a stratified subgroup analysis of a trial suggested a benefit of DES in terms of cardiac death, MI, and repeat revascularization in small vessels (stent diameter Ͻ3.0 mm) but the potential of harm in larger vessels. 80 Accordingly, BMS remain a valuable alternative to DES in large vessels with discrete lesions. A step further, balloon angioplasty remains a valid option in selected patients.…”

Section: Patient and Lesion Selectionmentioning

confidence: 99%

Late Coronary Stent Thrombosis

2007

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Introduced Ͼ20 years ago, 1 coronary artery stents have improved the safety and particularly the efficacy of percutaneous coronary interventions (PCIs). 2 Abrupt vessel closure, complicating 6% to 8% of balloon angioplasty procedures, was associated with a 5% mortality, 40% rate of myocardial infarction (MI), and 40% rate of emergency coronary artery bypass grafting. 3 Stents significantly reduced these adverse events (Figure 1). 4,5 The reduction of restenosis afforded by bare metal stents (BMS) was modest (30% to 40%). Repeat revascularization still occurred in 15% to 20% of cases. 6 Drug-eluting stents (DES) with antiproliferative drugs attached via polymers on the stent surface to minimize smooth muscle proliferation have reduced restenosis and rates of target lesion revascularization by 50% to 70% compared with BMS across nearly all lesion and patient subsets. 7 Initially 8 and again more recently, 9 -16 safety concerns were raised about DES, particularly about late stent thrombosis (ST). Historical PerspectiveST was a bane of stent implantation from the beginning. The initial experience with Wallstents in the late 1980s was overshadowed by ST rates approaching 24%. 17 Subsequent series with Palmaz-Schatz and Gianturco-Roubin stents (still predominantly bailout stenting) observed ST in 6% to 12% of cases. 4,18 The postprocedural antithrombotic regimen at the time consisted of aspirin, often in conjunction with oral anticoagulation. Dual antiplatelet therapy of aspirin and the thienopyridine ticlopidine in conjunction with a shift from bailout to elective stenting resulted in a significant reduction of ST to Ͻ2%. 5,19 Earlier oral antiplatelet drug loading and glycoprotein IIb/IIIa antagonists further diminished ST. Table 1 provides an overview of ST reported in contemporary trials of BMS and DES, ranging from 0.1% to 3.1%. 11,20 -38 The wide range in the incidence of ST across trials with both BMS and DES is explained by differences in definitions, length of follow-up, antithrombotic drug regimens, and complexity of patients and lesions.

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“…[18][19][20][21][22] Moreover, patients with small vessels or bypass grafts seem to benefit from the use of DES, as far as long-term outcome is concerned, in contrast to patients with large native vessel stenting in whom there can be late harm. 23,24 Emerging evidence of stent thrombosis that is fatal is a major limitation to the use of DES and so far there is consensus for the discontinuation of clopidogrel, because although the benefit of DES in reducing TLR is maintained, there is an increase in late cardiac death or nonfatal MI, possibly related to late stent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Safety of Drug-Eluting Stents in the Korea Acute Myocardial Infarction Registry

Lee

Jeong

Chae

et al. 2008

Circ J

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tent implantation is an effective treatment for coronary artery stenosis and is a commonly used strategy in percutaneous coronary intervention (PCI). At the present time, 2 drug-eluting stents (DES: sirolimus and paclitaxel) have made it into large clinical trials and seem to have fundamentally changed the treatment of coronary artery disease. DES are successful in most patients in preventing restenosis as compared with bare metal stents (BMS). [1][2][3][4][5] There are reports of the superiority of the sirolimuseluting stent (SES) over the paclitaxel-eluting stent (PES) in certain clinical groups such as those with diabetes or small vessels. [6][7][8] However, in truly head-to-head comparisons, such as the REALITY trial, there were no differences in the rate of binary restenosis and major adverse cardiac events (MACE) between the 2 types. 9 The importance of the angiographic endpoint of lower in-stent late luminal loss as representative of clinical events has been doubted and there are only a few published studies on the patterns of DES use in clinical practice. 10,11 Recent trials of DES in acute myocardial infarction However, there are growing questions about the actual usefulness of DES, because of the increased incidence of thrombosis and death in DES cases compared with BMS during follow-up. [15][16][17] Moreover, because there is more chance of a thrombotic condition in AMI, many clinicians have questioned the incidence of MACE and stent thrombosis in DES-implanted AMI patients during real-life clinical Circ J 2008; 72: 392 -398

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Targeted stent use in clinical practice based on evidence from the BAsel Stent Cost Effectiveness Trial (BASKET)

Abstract: Patients with angioplasty of small vessels or bypass grafts seem to benefit from DES use, in long-term outcome, in contrast to patients with large native vessel stenting where there might even be late harm. Still, this hypothesis needs to be tested prospectively.

Cited by 70 publications

References 34 publications

Drug-Eluting Stents Compared with Bare Metal Stents Improve Late Outcome after Saphenous Vein Graft but Not after Large Native Vessel Interventions

Drug-Eluting Stents Compared with Bare Metal Stents Improve Late Outcome after Saphenous Vein Graft but Not after Large Native Vessel Interventions

Late Coronary Stent Thrombosis

Clinical Safety of Drug-Eluting Stents in the Korea Acute Myocardial Infarction Registry

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