Impact of ultra-long second-generation drug-eluting stent implantation.

Abstract

OBJECTIVES:

This study investigated the safety and prognosis of ultra-long second DES (UL-2nd DES) implantation in real-world practice.

BACKGROUND:

Long stenting is a widely known predictor of stent thrombosis (ST) or target lesion revascularization (TLR) in first-generation drug-eluting stents (DES).

METHODS:

Participants were 1,669 patients (2,763 lesions) who had undergone successful second DES implantation; they were assigned to one of three groups: ultra-long 2nd DES (UL-DES; >50 mm, 166 patients, 259 lesions), long second DES (L-DES; 20-50 mm, 758 patients, 1,212 lesions), or short second DES (S-DES; <20 mm, 745 patients, 1,292 lesions). The primary endpoint was TLR, and secondary endpoints were ST, cardiac death, and major adverse cardiac events (MACE; composite of TLR, ST and cardiac death). A Cox proportional hazards model was used to identify independent predictors of TLR.

RESULTS:

Patient characteristics including dual antiplatelet therapy duration were similar across groups. Follow-up data were obtained from hospital charts, by contacting patients. Target lesion characteristics in the UL-DES group showed higher right coronary artery and chronic total occlusion lesion rates. TLR rates (23.1 ± 13.2 months) were significantly higher in the UL-DES group relative to other groups during follow up (P < 0.001). TLR rate was similar between S-DES and L-DES (P = 0.30). The incidence of ST was similar across groups (P = 0.40). MACE was significantly higher in the UL-DES group relative to other groups due to higher TLR rates (P = 0.01). In a Cox proportional hazard model, hemodialysis (RR: 2.53, 95% CI: 1.69-3.67, P < 0.001) and total stent length of >50 mm (RR: 1.67, 95% CI: 1.07-2.55, P = 0.02) were independent predictors of TLR.

CONCLUSIONS:

Ultra-long DES implantation was associated with higher TLR rates but did not increase ST, while long DES implantation up to 50 mm was safe and acceptable.

• Authors: Yohsuke Honda, Toshiya Muramatsu, Yoshiaki Ito, Tsuyoshi Sakai, Keisuke Hirano, Masahiro Yamawaki, Motoharu Araki, Norihiro Kobayashi, Hideyuki Takimura, Yasunari Sakamoto, Shinsuke Mouri, Masakazu Tsutumi, Takuro Takama, Hiroya Takafuji, Takahiro Tokuda, Kenji Makino
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 87 Issue 2 Pg. E44-53 (Feb 01 2016) ISSN: 1522-726X [Electronic] United States
• PMID: 26010548 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2015 Wiley Periodicals, Inc.

Topics

• Aged
• Aged, 80 and over
• Coronary Restenosis (diagnosis, mortality, physiopathology, therapy)
• Coronary Thrombosis (etiology)
• Drug-Eluting Stents
• Female
• Humans
• Japan
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (etiology)
• Percutaneous Coronary Intervention (adverse effects, instrumentation, mortality)
• Proportional Hazards Models
• Prosthesis Design
• Retreatment
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Vascular Patency