The BASKET study, presented in clinical trial update session I, identifies that to achieve optimal benefit drug eluting stents could be restricted to small vessels less than 3mmm and bypass grafts. Here presenter Christoph Kaiser (Basel, Switzerland) and discussant Jean Marco (Toulouse, France)provide an overview of the results.
Background
In order to define patient subgroups with a particularly high versus no or only minimal clinical benefit from DES compared with BMS use we anlayzed our “real-world” experience from BASKET after 18 months.
Methods
BASKET included 826 consecutive patients with PCI and stenting irrespective of indication. Patients were randomized 2:1 to DES versus BMS and followed up for 18 months for the occurrence of major adverse cardiac events (Cardiac death, non-fatal MI and non-MI related TVR). Based on tests for interaction with the different stent types, patient subgroups with high versus low clinical benefit from DES were indentified.
Results
Overall, event rates were low (DES vs. BMS: Death/MI: 8.4% vs. 7.5%; (p=0.63); Non-infarct related TVR: 7.5% vs. 11.6% (p=0.05); MACE: 15.8% vs. 18.9% (p=0.26). Overall, only bypass graft interventions and small vessel stenting < 3.0mm showed significant interactions between stent type and non-infarct related TVR as well as Death/ MI or MACE. Therefore, we analyzed outcomes in patients with versus without these two characteristics. Kaplan-Meier survival curves showed a highly significant benefit of patients with small vessel/stent or bypass graft PCI from DES use (Fig. 1). In contrast, for all other patients there was no benefit of DES compared to BMS.
Conclusion
Based on evidence from this long-term follow-up from BASKET, DES may be restricted to small vessels/stents <3mm and to bypass grafts for optimal and long-term benefit. These findings challenge the notion that today every patient should receive DES irrespective of baseline characteristics.
The BASKET study, presented in clinical trial update session I, identifies that to achieve optimal benefit drug eluting stents could be restricted to small vessels less than 3mmm and bypass grafts. Here presenter Christoph Kaiser (Basel, Switzerland) and discussant Jean Marco (Toulouse, France)provide an overview of the results.
Background
In order to define patient subgroups with a particularly high versus no or only minimal clinical benefit from DES compared with BMS use we anlayzed our “real-world” experience from BASKET after 18 months.
Methods
BASKET included 826 consecutive patients with PCI and stenting irrespective of indication. Patients were randomized 2:1 to DES versus BMS and followed up for 18 months for the occurrence of major adverse cardiac events (Cardiac death, non-fatal MI and non-MI related TVR). Based on tests for interaction with the different stent types, patient subgroups with high versus low clinical benefit from DES were indentified.
Results
Overall, event rates were low (DES vs. BMS: Death/MI: 8.4% vs. 7.5%; (p=0.63); Non-infarct related TVR: 7.5% vs. 11.6% (p=0.05); MACE: 15.8% vs. 18.9% (p=0.26). Overall, only bypass graft interventions and small vessel stenting < 3.0mm showed significant interactions between stent type and non-infarct related TVR as well as Death/ MI or MACE. Therefore, we analyzed outcomes in patients with versus without these two characteristics. Kaplan-Meier survival curves showed a highly significant benefit of patients with small vessel/stent or bypass graft PCI from DES use (Fig. 1). In contrast, for all other patients there was no benefit of DES compared to BMS.
Conclusion
Based on evidence from this long-term follow-up from BASKET, DES may be restricted to small vessels/stents <3mm and to bypass grafts for optimal and long-term benefit. These findings challenge the notion that today every patient should receive DES irrespective of baseline characteristics.
Session Number : 710003
Session Title: Clinical Trial Update I
Conclusion
DISCUSSANT: Marco, J.
Single centre randomized trial including « real-world » patients
18 month update of BASKET .... [Slide available]