Author + information
- Received August 16, 2011
- Revision received November 10, 2011
- Accepted November 11, 2011
- Published online February 28, 2012.
- Michael J. Zellweger, MD⁎,
- Christoph Kaiser, MD⁎,
- Raban Jeger, MD⁎,
- Hans-Peter Brunner-La Rocca, MD⁎,‡,
- Peter Buser, MD⁎,
- Franziska Bader, RN⁎,
- Jan Mueller-Brand, MD† and
- Matthias Pfisterer, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Matthias Pfisterer, University Hospital, Petersgraben 4, 4031 Basel, Switzerland
Objectives This study sought to define the importance of 5-year coronary artery disease (CAD) progression after successful stenting.
Background Safety concerns regarding first-generation drug-eluting stents mandate 5-year follow-up studies. However, only limited data exist on the long-term importance of CAD progression relative to late stent–related problems.
Methods This study followed for 5 years, 428 consecutive patients randomized to drug-eluting versus bare-metal stents with successful stenting documented by freedom from symptoms/events and no ischemic perfusion defects (PDs) after 6 months. Rest/stress scintigraphic scans were repeated after 60 months. Late events and new PDs in areas remote from stented vessels indicated CAD progression.
Results During follow-up, 110 of 428 (25.7%) patients had 150 clinical events: 43 patients (10%) died, 36 (8.4%) suffered a myocardial infarction, and 71 (16.6%) needed repeat revascularization. Event rates were lower in remote versus target-vessel areas (9.8% vs. 14.3%, p = 0.019). Remote myocardial infarction and repeat revascularization accounted for 46 of 124 (37.1%) nonfatal events and were similar for both stent types. Five-year scintigraphic studies in patients without follow-up events showed 23.3% new PDs, 71% of which were asymptomatic. Remote defects accounted for 37.5% PDs and were similar for both stent types.
Conclusions Even 5 years after stenting, target-vessel events and/or new PDs remained more frequent than CAD progression assessed by remote events and/or new PDs. Still, remote events accounted for almost 40% of all events with a similar rate of additional new PDs, often silent, and independent of stent type. This documents the importance of CAD progression and stresses the need to differentiate remote from target-vessel events/PDs in long-term stent safety studies. (Basel Stent Kosten-Effektivitäts Trial [BASKET]; ISRCTN75663024)
- coronary artery disease
- myocardial perfusion imaging
- outcome research
- percutaneous transluminal coronary angioplasty
This study was supported by the Basel Cardiovascular Research Foundation, Basel, and the Swiss Heart Foundation, Berne, Switzerland. They had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Zellweger and Kaiser contributed equally to this study.
- Received August 16, 2011.
- Revision received November 10, 2011.
- Accepted November 11, 2011.
- American College of Cardiology Foundation