TY - JOUR
T1 - Coronary Artery Disease Progression Late After Successful Stent Implantation
AU - Zellweger, Michael J.
AU - Kaiser, Christoph A.
AU - Jeger, Raban V.
AU - Brunner-La Rocca, Hans-Peter
AU - Buser, Peter T.
AU - Bader, Franziska
AU - Mueller-Brand, Jan
AU - Pfisterer, Matthias Emil
PY - 2012/2/28
Y1 - 2012/2/28
N2 - 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.
AB - 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.
KW - coronary artery disease
KW - myocardial perfusion imaging
KW - outcome research
KW - percutaneous transluminal coronary angioplasty
KW - stents
U2 - 10.1016/j.jacc.2011.11.024
DO - 10.1016/j.jacc.2011.11.024
M3 - Article
C2 - 22361397
SN - 0735-1097
VL - 59
SP - 793
EP - 799
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 9
ER -