Drug-eluting stents and bare metal stents in patients with NSTE-ACS: 2-year outcome from the randomised BASKET-PROVE trial.
OBJECTIVE
The use of drug-eluting stents (DES) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is controversial and not yet endorsed in clinical guidelines.


RESULTS
This was an a priori planned post hoc analysis involving 754 NSTE-ACS patients from the randomised BASKET-PROVE trial (sirolimus-eluting stent vs. everolimus-eluting stent vs. bare metal stent in large-vessel stenting). The primary endpoint was the combined two-year rate of cardiovascular death or non-fatal myocardial infarction (MI). Secondary endpoints were each component of the primary endpoint, and clinically indicated target vessel revascularisation (TVR) and stent thrombosis. Compared to patients with BMS, those treated with SES and EES had a strong trend towards lower two-year rates of the primary endpoint (HR: 0.31 [CI: 0.11-0.90], p=0.03, and HR: 0.74 [CI: 0.44-1.24], p=0.25), and of TVR (HR: 0.58 [CI: 0.29-1.15], p=0.12) and (HR: 0.52 [CI: 0.34-0.78], p=0.002). When the SES and EES groups were combined and compared to BMS, significant reductions in both cardiovascular death/MI and TVR were found.


CONCLUSIONS
Compared with BMS, use of DES in NSTE-ACS patients undergoing stent implantation in large vessels was associated with a reduction in both TVR and the combined endpoint consisting of cardiovascular death/MI. Thus, DES use improves both efficacy and safety. These findings support the use of DES in NSTE-ACS patients.
Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark.
Sune Haahr
SH
Pedersen
Matthias
M
Pfisterer
Christoph
C
Kaiser
Jan Skov
JS
Jensen
Hannes
H
Alber
Peter
P
Rickenbacher
Rikke
R
Sørensen
Allan
A
Iversen
Magnus Thorsten
MT
Jensen
Kim
K
Wadt
Søren
S
Galatius
D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D023903:Coronary Restenosis; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016016:Proportional Hazards Models; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D015607:Stents; D013927:Thrombosis; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus