title: Impact of Preexisting Vascular Disease on the Outcome of Patients With Acute Coronary Syndrome: Insights From the Comparison of Bioactive Stent to the Everolimus-Eluting Stent in Acute Coronary Syndrome Trial.
abstract: The Comparison of Bioactive-Stent to the Everolimus-Eluting Stent in Acute Coronary Syndrome (BASE-ACS) trial demonstrated an outcome of titanium-nitride-oxide-coated bioactive stents (BAS) non-inferior to everolimus-eluting stents (EES) in patients presenting with acute coronary syndrome (ACS). We performed a post hoc analysis of the BASE-ACS trial in patients with, versus those without, preexisting vascular disease. We randomized 827 patients (1:1) presenting with ACS to receive either BAS or EES. The primary end point was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction (MI), or ischemia-driven target lesion revascularization (TLR). A total of 169 (20.4%) patients had preexisting vascular disease. Median follow-up was 5.0 years. The incidence of MACE was higher in patients with, versus those without, preexisting vascular disease (22.5% vs 13.5%, respectively, P = .004). This was driven by more frequent cardiac death and non-fatal MI (5.9% vs 2.4% and 11.8% vs 5.5%, P = .02 and P = .003, respectively). The rates of ischemia-driven TLR were comparable ( P > .05). All events were comparable between the 2 matched-pair subgroups ( P > .05 for all). In patients treated with early percutaneous coronary intervention for ACS, the long-term outcome was worse in patients with, versus those without, preexisting vascular disease.
authors.affiliation: 1 Heart Center, Satakunta Central Hospital, Pori, Finland.
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
authors.affiliation: 2 Heart Center, Turku University Hospital, Turku, Finland.
authors.forename: Juhani K E
authors.initials: JKE
authors.lastname: Airaksinen
authors.affiliation: 3 Division of Cardiology, Department of Internal Medicine, University of Oulu, Oulu, Finland.|4 Heart Centre, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Romppanen
authors.affiliation: 5 Department of Cardiology, Kokkola Central Hospital, Kokkola, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Sia
authors.affiliation: 6 Department of Cardiology, Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: de Belder
authors.affiliation: 1 Heart Center, Satakunta Central Hospital, Pori, Finland.
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Karjalainen
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000368:Aged; D020099:Coated Materials, Biocompatible; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D023381:Endpoint Determination; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D057216:Propensity Score; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications*
chemical_list: D020099:Coated Materials, Biocompatible; D000068338:Everolimus
keywords: acute coronary syndrome; everolimus-eluting stents; titanium-nitride-oxide-coated stents; vascular disease