Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Research Cardiology 2009;112:49–55 DOI: 10.1159/000137699 Drug-Eluting Stents Compared with Bare Metal Stents Improve Late Outcome after Saphenous Vein Graft but Not after Large Native Vessel Interventions Raban V. Jeger Stefan Schneiter Christoph Kaiser Piero O. Bonetti Hanspeter Brunner-La Rocca Michael Handke Stefan Osswald Peter T. Buser Matthias E. Pfisterer for the BASKET Investigators Department of Cardiology, University Hospital Basel, Basel, Switzerland stenting, no significant difference was noted (MACE: 13 vs. 16%, p = 0.40). Conclusions: Among patients with SVG dis- ease, treatment with DES resulted in a better long-term out- come than treatment with BMS. In contrast, no DES benefit was found in similarly sized native vessels regarding MACE. Copyright © 2008 S. Karger AG, Basel Introduction Interventional revascularization therapy after coro- nary artery bypass graft (CABG) surgery needs to be per- formed in 1–2% of patients per year within the first 5 years after surgery and in 4% per year subsequently [1]. While atherosclerotic changes leading to severe obstruc- tion or occlusion are present in almost half of all saphe- nous vein grafts (SVG) after 11 years, the degeneration of these grafts starts early after surgery [1]. Until recently, the standard treatment of SVG atherosclerosis was to re- peat CABG [2]. However, angioplasty alone [3–6] and an- gioplasty with stenting [7–11] have emerged as alternative treatment options in the last years. Thus, treatment of SVG disease currently accounts for about 10% of all per- cutaneous coronary interventions (PCI) [12] . Since em- bolization of friable material was a main problem with Key Words Coronary artery bypass grafting  Percutaneous coronary intervention  Stents  Survival  Thrombosis Abstract Objectives: To define long-term efficacy of different stent types in saphenous vein graft (SVG) interventions. Methods: In BASKET (Basel Stent Cost Effectiveness Trial), major ad- verse cardiac events (MACE), i.e. cardiac death, myocardial infarction and symptom-driven target vessel revasculariza- tion (TVR) were assessed after 18 months comparing drug- eluting stents (DES) versus bare metal stents (BMS), and SVG and large native vessels ( 63.0 mm). Results: Large vessel in- terventions were performed in 605 patients. Patients with SVG interventions (n = 47, 8%) were older and had more of- ten hypertension, prior myocardial infarction, prior revascu- larization and multivessel disease and less frequent ST-ele- vation myocardial infarction than patients with large native vessel interventions (n = 558, 92%). Stent number and length were higher in SVG than in large native vessel interventions. Baseline characteristics were similar for DES and BMS. In SVG stenting, long-term outcome was better in DES- than in BMS-treated patients (MACE 21 vs. 62%, p = 0.007, mainly due to TVR 18 vs. 46%, p = 0.045), but for large native vessel Received: December 3, 2007 Accepted after revision: January 25, 2008 Published online: June 26, 2008 Prof. Matthias E. Pfisterer, MD Department of Cardiology University Hospital CH–4031 Basel (Switzerland) Tel. +41 61 265 52 14, Fax +41 61 265 45 98, E-Mail pfisterer@email.ch © 2008 S. Karger AG, Basel 0008–6312/09/1121–0049$26.00/0 Accessible online at: www.karger.com/crd Downloaded by: Universitätsbibliothek Medizin Basel 131.152.211.61 - 10/25/2017 10:39:14 AM