Stent Length and Long-Term Outcomes after Percutaneous Coronary Intervention with New-Generation Drug-Eluting Stents

Abstract

Background: Percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) ≥20 mm in length is increasingly being used in the treatment of significant coronary artery disease (CAD). We evaluated the long-term effectiveness and safety of long DESs in patients with diffuse CAD. Methods and Results: A total of 4,722 patients with CAD undergoing PCI with new-generation DESs were analyzed. The patients were classified into the short (stented length <20 mm, n=1,050), intermediate (stented length ≥20 mm, <40 mm, n=2,672), and long (stented length ≥40 mm, n=1,000) stent groups. The primary outcome was target lesion failure (TLF), defined as a composite of cardiac death, target-vessel myocardial infarction, or target lesion revascularization. During the follow-up period (median 49.1 months), the 4-year rate of TLF significantly increased according to the stented length (5.1% in the short stent group, 9.1% in the intermediate stent group, and 18.1% in the long stent group, p<0.001). Similarly, the rate of death from any cause or target vessel myocardial infarction was significantly higher in the long stent group than the short or intermediate stent group. Long stent, but not intermediate stent, was an independent predictor of all-cause death or cardiac death compared to short stent. Conclusions: Patients with long stent implantation showed a higher risk for TLF and death after PCI with new-generation DESs than those with short or intermediate stent implantation. In the current DESs era, it may be appropriate to redefine long lesions as those requiring a stented length ≥40 mm.