Coronary Artery Disease Progression Late After Successful Stent Implantation

Michael J. Zellweger, Christoph A. Kaiser, Raban V. Jeger, Hans-Peter Brunner-La Rocca, Peter T. Buser, Franziska Bader, Jan Mueller-Brand, Matthias Emil Pfisterer*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

40 Citations (Web of Science)

Abstract

This study sought to define the importance of 5-year coronary artery disease (CAD) progression after successful stenting.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.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.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.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-Effektivit?ts Trial [BASKET]; ISRCTN75663024). American College of Cardiology Foundation.
Original languageEnglish
Pages (from-to)793-799
JournalJournal of the American College of Cardiology
Volume59
Issue number9
DOIs
Publication statusPublished - 28 Feb 2012

Keywords

  • coronary artery disease
  • myocardial perfusion imaging
  • outcome research
  • percutaneous transluminal coronary angioplasty
  • stents

Cite this