Impact of ultra‐long second‐generation drug‐eluting stent implantation

• DOI: 10.1002/ccd.26010
• Publication Date: 2015-05-23T08:16:57Z
• 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
• Keywords: Aged, 80 and over; Male; Time Factors; Coronary Thrombosis; Myocardial Infarction; Drug-Eluting Stents; Kaplan-Meier Estimate; Middle Aged; Prosthesis Design; 3. Good health; Coronary Restenosis; 03 medical and health sciences; Percutaneous Coronary Intervention; 0302 clinical medicine; Japan; Risk Factors; Multivariate Analysis; Retreatment; Humans; Female; Aged; Proportional Hazards Models; Retrospective Studies

ObjectivesThis study investigated the safety and prognosis of ultra‐long second DES (UL‐2nd DES) implantation in real‐world practice.BackgroundLong stenting is a widely known predictor of stent thrombosis (ST) or target lesion revascularization (TLR) in first‐generation drug‐eluting stents (DES).MethodsParticipants 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.ResultsPatient 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.ConclusionsUltra‐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. © 2015 Wiley Periodicals, Inc.