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Review article: Biomedical intelligence

Vol. 141 No. 3536 (2011)

Drug-eluting coronary stents in clinical practice: lessons from the «BAsel Stent Kosten-Effektivitäts Trials» (BASKET)

  • Matthias Pfisterer
  • Fabian Nietlispach
  • Raban Jeger
  • Christoph Kaiser
Cite this as:
Swiss Med Wkly. 2011;141:w13263


In this review of the BAsel Stent Kosten-Effektivitäts Trial (BASKET) the trials and their impact on coronary stenting practice were examined, basing the clinical questions of each study on the findings of the previous study. Are the new drug-eluting stents (DES) cost-effective compared to standard bare-metal stents (BMS) if used in all patients? No. Are there specific subgroups of patients with a particular benefit? Yes. A “targeted stent use” was proposed for daily practice. What is the long-term safety of DES? Unexpected safety problems were observed. Was this a chance finding? No. However, with improved stenting techniques, newer stents and intensified antiplatelet regimens late problems were minimised as shown in the BASKET-PROspective Validation Examination (BASKET-PROVE). Further stent developments? Wait and see! – Many additional questions were raised and answered or are still under investigation. Obviously, answers were not always simple and needed a closer look and this is discussed. The BASKET trials proceeded not only from one question to the other, but also in size and methodology. From the restricted single-centre “local” BASKET study to multicentre international long-term trials, all prospective, randomized and investigator-driven. Their relevance was acknowledged by publications in major medical journals as well as by their impact on US and European practice guidelines and on DES research. These aspects are summarised in the present review, highlighting lessons learned from each study and commenting on the possibilities and difficulties of performing such clinical research in Switzerland.


  1. Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002;346:1773–80.
  2. Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003;349:1315–23.
  3. Schofer J, Schluter M, Gershlick AH, Wijns W, Garcia E, Schampaert E, et al. Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: double-blind, randomised controlled trial (E-SIRIUS). Lancet. 2003;362:1093–9.
  4. Lemos PA, Serruys PW, van Domburg RT, Saia F, Arampatzis CA, Hoye A, et al. Unrestricted utilization of sirolimus-eluting stents compared with conventional bare stent implantation in the “real world”: the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. Circulation. 2004;109:190–5.
  5. Kaiser C, Brunner-La Rocca HP, Buser PT, Bonetti PO, Osswald S, Linka A, et al. Incremental cost-effectiveness of drug-eluting stents compared with a third-generation bare-metal stent in a real-world setting: randomised Basel Stent Kosten Effektivitats Trial (BASKET). Lancet. 2005;366:921–9.
  6. Brunner-La Rocca HP, Kaiser C, Bernheim A, Zellweger MJ, Jeger R, Buser PT, et al. Cost-effectiveness of drug-eluting stents in patients at high or low risk of major cardiac events in the Basel Stent KostenEffektivitats Trial (BASKET): an 18-month analysis. Lancet. 2007;370:1552–9.
  7. Pfisterer M, Brunner-La Rocca HP, Buser PT, Rickenbacher P, Hunziker P, Mueller C, et al. Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol. 2006;48:2584–91.
  8. Lagerqvist B, James SK, Stenestrand U, Lindback J, Nilsson T, Wallentin L. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med. 2007;356:1009–19.
  9. Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA. 2007;297:159–68.
  10. Nordmann AJ, Bbriel M, Buchetr HC. Mortality in randomized controlled trials comparing drug-eluting vs bare-metal stents in coronary artery disease: a meta-analysis. Eur Heart J. 2006;27:2784–814.
  11. Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation of drug-eluting stents: a cause for concern. Circulation. 2007;115:1440–55.
  12. Pinto Slottow TL, Waksman R. Overview of the 2006 Food and Drug Administration Circulatory System Devices Panel meeting on drug-eluting stent thrombosis. Catheter Cardiovasc Interv. 2007;69:1064–74.
  13. Brunner-La Rocca HP, Kaiser C, Pfisterer M. Targeted stent use in clinical practice based on evidence from the Basel Stent Cost Effectiveness Trial (BASKET). Eur Heart J. 2007;28:719–25.
  14. Zellweger MJ, Kaiser C, Brunner-La Rocca HP, Buser PT, Osswald S, Weiss P, et al. Value and limitations of target-vessel ischemia in predicting late clinical events after drug-eluting stent implantation. J Nucl Med. 2008;49:550–6.
  15. Pfisterer M, Brunner-La Rocca HP, Rickenbacher P, Hunziker P, Mueller C, Nietlispach F, et al. Long-term benefit-risk balance of drug-eluting vs. bare-metal stents in daily practice: does stent diameter matter? Three-year follow-up of BASKET. Eur Heart J. 2009;30:16–24.
  16. Daemen J, Simoons ML, Wijns W, et al. ESC forum on drug-eluting stents. European Heart House, Nice, 27–29 9.2007. Eur Heart J. 2009;30(2):152–61.
  17. Pfisterer M, Bertel O, Bonetti PO, et al. Drug-eluting or bare-metal stents for large coronary vessel stenting? The BASKET-PROVE (PROspective Validation Examination) trial: study protocol and design. Am Heart J. 2008;255:609–14.
  18. Kaiser C, Galatius S, Erne P, Eberli F, Alber H, Rickli H, et al. Drug-eluting versus bare-metal stents in large coronary arteries. N Engl J Med. 2010;363:2310–9.
  19. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001–15.
  20. Jeger R, Pfisterer M, Alber H, et al. Two-Year Outcomes of Newest-Generation Stents in Large Coronary Arteries: The BAsel Stent Kosten Effektivitäts Trial PROspective Validation Examination part II (BASKET-PROVE II). Am Heart J (in press)
  21. Leibundgut G, Nietlispach F, Pittl U, Brunner-La Rocca H, Kaiser CA, Pfisterer ME. Stent thrombosis up to 3 years after stenting for ST-segment elevation myocardial infarction versus for stable angina – comparison of the effects of drug-eluting versus bare-metal stents. Am Heart J. 2009;158:271–6.
  22. Jeger RV, Brunner-La Rocca HP, Bertel O, Kiowski W, Pfisterer ME, Kaiser CA. Stent thrombosis after coronary stent implantation: a protective effect of high dose statin therapy? (submitted).
  23. Halg C, Brunner-La Rocca HP, Kaiser C, Jeger R, Osswald S, Pfisterer M, et al. Early and late increased bleeding rates after angioplasty and stenting due to combined antiplatelet and anticoagulant therapy. EuroIntervention. 2009;5:425–31.
  24. Jeger RV, Schneiter S, Kaiser C, et al. Drug-eluting stent compared with bare-metal stents improve late outcomes after saphenous vein graft but not after large native vessel interventions. Cardiology. 2009;112:49–55.
  25. Zellweger M, Kaiser C, Jeger R, et al. Coronary artery disease progression late after successful stent implantation. (submitted).

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