Impact of single-vessel stent length on long-term clinical outcomes in acute myocardial infarction patients treated with drug-eluting stents

BACKGROUND AND AIMS Coronary stent length has been considered an important predictor of adverse events in stable patients undergoing percutaneous coronary intervention (PCI). However, data regarding on the impact of long drug-eluting stent (DES) length on the clinical outcomes in acute myocardial infarction (AMI) patients are limited. METHODS The study analyzed a total of 9021 AMI patients who underwent PCI with 2nd generation DESs from Korea AMI registry-National Institutes of Health. The patients were categorized into three groups according to the stent length (SL) in a treated coronary artery: <38 mm, n = 6821, 38-59 mm, n = 1735 and ≥60 mm, n = 465 and compared using the inverse probability of treatment-weighted (IPTW) method. The primary endpoint was the incidence of major adverse cardiac events up to 3 years. RESULTS After adjustment for differences in the baseline risk factors, SL was significantly associated with higher cumulative rates of MACE [Odds ratio (OR) 1.15 for 38-59mm group, 95% confidence interval (CI): 1.06-1.26, p = 0.001, and OR 1.23 for ≥60mm group, 95% CI:1.13-1.34, p < 0.001], especially, non target vessel revascularization (TVR), not TVR. Stent thrombosis (ST) showed a significant association with long DESs after IPTW. Patients with very long DESs ≥60 mm showed a markedly higher risk (HR: 1.798, 95% CI: 1.149-2.814, P = 0.010). CONCLUSIONS DES length reflecting diffuse coronary atherosclerosis was associated with adverse long-term clinical outcomes in AMI patients treated with 2nd generation DESs. Long stent implantation did not affect TVF but was associated with increased non-TVR. Although the incidence of ST is low, patients with SL ≥60 mm had an increased risk of ST, underscoring an important consideration during PCI.