World Congress of Cardiology Report - Drug-eluting stents (DES) are more effective than bare-metal stents (BMS) in reducing restenosis and in repeat interventions after percutaneous coronary interventions (PCI).
However, late stent thromboses after DES implantation and higher costs have stimulated a new debate about whether all patients should receive DES. In an attempt to answer some questions, we used our "real-world" experience to define patient subgroups by comparing those with a very high clinical benefit from DES vs BMS use, to those with no benefit or only minimal benefit from the treatment.
In the prospective, randomised BASKET-Trial, all patients treated by PCI/stenting between May 2003 and May 2004 in the UniversityHospital of Basel, Switzerland, were included and randomised to receive Cypher, Taxus or Vision stents. Endpoints of the present analysis were cardiac death and myocardial infarction (Death/MI) up to 18 months after the procedure as well as occurrence of non-infarct related target vessel revascularization (TVR) and major cardiac adverse events (MACE). Based on multivariate event prediction analyses and tests for interaction with the different stent types, patient subgroups with high vs low clinical benefit from DES were identified.
Overall, event rates were low in all groups. Eighteen months rates of Death/MI was 8.4% for DES and 7.5% for BMS (p=0.63). There was, however, a significantly higher rate of non-infarct related TVR after BMS: 11.6% vs 7.5% after DES (p=0.05). This resulted in similar overall MACE rates after 18 months: 15.8% vs 18.9%, DES vs BMS respectively (p=0.26).