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European Heart Journal Advance Access originally published online on February 13, 2007
European Heart Journal 2007 28(6):719-725; doi:10.1093/eurheartj/ehl490
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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

Hans-Peter Brunner-La Rocca, Christoph Kaiser, Matthias Pfisterer on behalf of the BASKET Investigators*

Division of Cardiology, University Hospital Basel, CH 4031, Switzerland

Received 10 October 2006; revised 27 December 2006; accepted 4 January 2007; online publish-ahead-of-print 13 February 2007.

* Corresponding author. Tel: +41 61 265 25 25/52 14; fax: +41 61 265 45 98. E-mail address: pfisterer{at}email.ch

See page 653 for the editorial comment on this article (doi:10.1093/eurheartj/ehl566)

Aim It is unknown which patients benefit most from drug-eluting stents (DES) against bare-metal stents (BMS) in a long-term clinical outcome.

Methods and results To address this question, data from 826 consecutive patients with angioplasty, randomized 2:1 to DES vs. BMS, with an 18-month follow-up for cardiac death/myocardial infarction (MI) and non-MI-related target-vessel revascularization (TVR) were analysed for interactions between stent type and patient/vessel characteristics predicting events. Rates of 18-month TVRs were lower with DES vs. BMS use (7.5 vs. 11.6%, P = 0.05), but similar for both stents regarding cardiac death/MI (DES, 8.4%; BMS, 7.5%; P = 0.70). Significant interactions between stent type and two multivariable event predictors were identified: small stents (<3.0 mm) and bypass graft stenting. In these patient groups together (n = 268, 32%), DES reduced non-MI-related TVR (HR = 0.44; P = 0.02) and cardiac death/MI (HR = 0.44; P = 0.04), whereas in the other 558 patients (68%) TVR rate was similar (HR = 0.75; P = 0.38) and cardiac death/MI rate increased after DES (HR = 2.07; P = 0.05).

Conclusion 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.

Key Words: Angioplasty • Coronary disease • Outcome • Stents • Stent thrombosis


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