European Heart Journal Advance Access originally published online on July 2, 2007
European Heart Journal 2007 28(15):1912-1913; doi:10.1093/eurheartj/ehm205
Targeted stent use in clinical practice based on evidence from the Basel Stent Cost Effectiveness Trial (BASKET)
Antwerp Cardiovascular Institute Middelheim
AZ Middelheim
Lindendreef 1
2020 Antwerp
Belgium
Antwerp Cardiovascular Institute Middelheim
AZ Middelheim
Antwerp
Belgium
Antwerp Cardiovascular Institute Middelheim
AZ Middelheim
Antwerp
Belgium
Antwerp Cardiovascular Institute Middelheim
AZ Middelheim
Antwerp
Belgium
Antwerp Cardiovascular Institute Middelheim
AZ Middelheim
Antwerp
Belgium
Antwerp Cardiovascular Institute Middelheim
AZ Middelheim
Antwerp
Belgium
Antwerp Cardiovascular Institute Middelheim
AZ Middelheim
Antwerp
Belgium
Tel: +32 484 086933 Fax: +32 3 2803220 E-mail address: agostonipf{at}gmail.com
We read with great interest the accurate retrospective analysis of the database of the BASKET trial, performed by Brunner-La Rocca et al.1 with the purpose to find patient/vessel characteristics predictive of future events.
In particular, we welcome the interesting finding of a potential interaction between stent type and two multivariable event predictors: small stents (<3 mm) and bypass graft stenting, suggesting the largest benefit of drug-eluting stents (DES) in these two specific settings.
In light of these results, we suggest the authors to provide raw data (possibly in a table) for these two separate cohorts of patients (those receiving small stents and those treated in bypass grafts), and not only the Kaplan–Meier curves for the total cohort of patients treated (as shown in Figure 3 of the manuscript). Indeed, while there is already enough evidence related to the benefits, in terms of repeated revascularization procedures, of DES over bare metal stents in small vessels,2,3 little data exist on the percutaneous treatment of bypass grafts with DES,4 and only a minority of these data come from controlled prospective studies.5
Despite the absolute number of patients treated for bypass lesions in the BASKET trial is small (overall 47 patients, as evident in Table 1), a clear quantification of events (according to stent type) in this group would be helpful to obtain a first estimate of the expected rate of events in clinical practice. These data would also be potentially useful to plan future trials dedicated to DES in bypass grafts (due to the paucity of data coming from prospective studies).
Additionally, we believe it should be worthwhile to clarify whether the bypass conduits treated inside the trial were all venous grafts or also arterial conduits.
References
- Brunner-La Rocca HP, Kaiser C, Pfisterer M, behalf of the BASKET Investigators. Targeted stent use in clinical practice based on evidence from the Basel Stent Cost Effectiveness Trial (BASKET). Eur Heart J (2007) 28:719–725.
[Abstract/Free Full Text] - Schofer J, Schluter M, Gershlick AH, Wijns W, Garcia E, Schampaert E, Breithardt G, E-SIRIUS Investigators. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: double-blind, randomised controlled trial (E-SIRIUS). Lancet (2003) 362:1093–1099.[CrossRef][Web of Science][Medline]
- Stone GW, Ellis SG, Cannon L, Mann JT, Greenberg JD, Spriggs D, O'Shaughnessy CD, DeMaio S, Hall P, Popma JJ, Koglin J, Russell ME, TAXUS V Investigators. Comparison of a polymer-based paclitaxel-eluting stent with a bare metal stent in patients with complex coronary artery disease: a randomized controlled trial. JAMA (2005) 294:1215–1223.
[Abstract/Free Full Text] - Vermeersch P, Agostoni P. Should degenerated saphenous vein graft routinely be sealed with drug-eluting stents? J Interven Cardiol (2005) 18:467–473.[CrossRef][Medline]
- Vermeersch P, Agostoni P, Verheye S, Van den Heuvel P, Convens C, Bruining N, Van den Branden F, Van Langenhove G. Randomized double-blind comparison of sirolimus eluting stent versus bare metal stent implantation in diseased saphenous vein grafts: 6-month angiographic, intravascular ultrasound and clinical follow up of the RRISC trial. J Am Coll Cardiol (2006) 48:2423–2431.
[Abstract/Free Full Text]
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