title: Coronary artery disease progression late after successful stent implantation.
abstract: OBJECTIVE
  This study sought to define the importance of 5-year coronary artery disease (CAD) progression after successful stenting.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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-Effektivitäts Trial [BASKET]; ISRCTN75663024).
authors.affiliation: Division of Cardiology, University Hospital, Basel, Switzerland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zellweger
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.forename: Raban
authors.initials: R
authors.lastname: Jeger
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner-La Rocca
authors.forename: Peter
authors.initials: P
authors.lastname: Buser
authors.forename: Franziska
authors.initials: F
authors.lastname: Bader
authors.forename: Jan
authors.initials: J
authors.lastname: Mueller-Brand
authors.forename: Matthias
authors.initials: M
authors.lastname: Pfisterer
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors