Author + information
- Akiko Fujino1,
- Akiko Maehara1,
- Yangbo Liu1,
- Pieter Smits2,
- Clemens von Birgelen3,
- Martin Leon4,
- Patrick Serruys5,
- Gary Mintz1 and
- Gregg Stone6
- 1Cardiovascular Research Foundation, New York, New York, United States
- 2Maasstad Ziekenhuis, Rotterdam, Netherlands
- 3Thoraxcentrum Twente, Enschede, Netherlands
- 4Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 5Imperial College, London, United Kingdom
- 6Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Whether treatment of diffuse coronary artery disease with long stents has deleterious consequences independent of adverse events such as MI, stent thrombosis and restenosis is unknown.
We combined data from 19 large-scale randomized trials evaluating BMS or DES into a single pt-level database (n=25,032). After excluding pts presenting with STEMI, those undergoing multilesion treatment, and all those in whom a MI, stent thrombosis, or target lesion revascularization (TLR) occurred during 5-yr follow-up, 8,612 pts with a single treated lesion remained. Implanted total stent length was categorized as ≤25mm, 25-50mm, or >50mm, with ≤25mm used as the reference. The primary endpoint was cardiac death at 5 yrs; outcomes were adjusted for age, sex, diabetes, current smoking, hypertension, hyperlipidemia, prior CABG, prior PCI, prior MI, ACS presentation, and use of 2nd generation DES.
3,707 pts had a single treated LAD lesion and 4,905 pts had a single treated non-LAD lesion. A >50 mm long stent was implanted in 230 (6.2%) LAD lesions and 311 (6.3%) non-LAD lesions. 5-yr cardiac mortality in LAD-stented pts was 2.4% (stent length ≤25mm: 2.4%; 25-50mm: 1.8%; >50mm: 4.6%, p=0.10). 5-yr cardiac mortality in pts with a non-LAD stent was 3.1% (≤25mm: 3.2%; 25-50mm: 2.8%; >50mm: 3.3%, p=0.50). By multivariable analysis a >50mm long stent in an LAD (but not in a non-LAD location) was an independent predictor for cardiac death at 5 yrs (Table).
|Covariate||LAD (n=3707)||Non-LAD (n=4905)|
|HR (95% CI)||p-value||HR (95% CI)||p-value|
|25-50mm vs ≤25mm||0.92 (0.51, 1.67)||0.78||0.92 (0.59, 1.42)||0.69|
|>50mm vs ≤25mm||2.28 (1.04, 5.01)||0.04||1.42 (0.72, 2.78)||0.31|
|Age (per 10 yrs)||2.16 (1.64, 2.83)||<0.0001||1.80 (1.46, 2.21)||<0.0001|
|Diabetes||2.11 (1.20, 3.71)||0.01||1.89 (1.22, 2.92)||0.004|
|Current smoking||2.03 (1.10, 3.75)||0.02||1.42 (0.88, 2.26)||0.15|
|Prior CABG||2.25 (1.03, 4.90)||0.04||1.08 (0.60, 1.92)||0.80|
|Prior MI||1.74 (0.99, 3.04)||0.05||1.60 (1.06, 2.41)||0.03|
Implanting a long stent (>50mm) in the LAD may be associated with increased mortality at 5 yrs, even in pts without clinically evident myonecrosis, stent thrombosis or TLR. Further studies are required to confirm and evaluate the mechanism of this observation.
CORONARY: PCI Outcomes