Key result
New-generation DES in very small vessels linked to ~72% lower TLF risk versus small vessels.
Why the study?
Treating vessels with a very small reference vessel diameter in coronary artery disease is challenging, warranting long-term evaluation of new-generation drug-eluting stents across different vessel sizes.
Does the use of new-generation drug-eluting stents in very small vessels (≤ 2.25 mm) improve target lesion failure compared to larger vessels in patients with coronary artery disease?
Observational (n=780)
Does the use of new-generation drug-eluting stents in very small vessels (≤ 2.25 mm) improve target lesion failure compared to larger vessels in patients with coronary artery disease?
New-generation drug-eluting stents demonstrate safe and effective long-term outcomes with low rates of target lesion failure and MACE when used in very small coronary vessels (≤ 2.25 mm).
BACKGROUND: Treating vessels with a very small reference vessel diameter (RVD) in coronary artery disease is challenging. OBJECTIVE: Long-term evaluation of new-generation drug-eluting stents (DESs) for the treatment of coronary lesions with different RVDs. METHODS: From April 2009 to March 2019, 780 patients who underwent single coronary stenting were divided into ≤ 2.25 (very small), 2.5-3.0 (small), and ≥ 3.5 mm (large) DES groups after 1:2:2 propensity score matching. The primary endpoint was target lesion failure (TLF), and the secondary endpoints were major adverse cardiac events (MACEs) and stent thrombosis (ST). RESULTS: During 3 years after new-generation DES implantation, TLF and MACE rates were significantly lower in the very small DES group. The risk of TLF was significantly lower in the very small DES group compared to the small DES group [very small vs. small: TLF, adjusted hazard ratio (HR) = 0.282, p = 0.040]. The risks of MACEs and all-cause mortality were significantly lower in the very small DES group compared to the small DES group (very small vs. small: MACEs, adjusted HR = 0.215, p = 0.001; all-cause mortality, adjusted HR = 0.181, p = 0.005). The cumulative incidence rates of TLF-free (log-rank test p = 0.001) and MACE-free (log-rank test p < 0.001) survival were significantly different among the groups, and the very small DES group had a high event-free survival rate. No cases of ST occurred in any group. CONCLUSIONS: Our results indicate that the use of new-generation DESs for treating coronary lesions in very small vessels is safe and effective.
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Chang et al. (2021) conducted an observational in coronary artery disease (n=780). New-generation drug-eluting stents (DESs) in very small vessels (≤ 2.25 mm) vs. Small (2.5-3.0 mm) and large (≥ 3.5 mm) DES groups was evaluated on target lesion failure (TLF) (adjusted HR 0.282, p=0.040). New-generation drug-eluting stents in very small vessels (≤ 2.25 mm) were associated with a significantly lower risk of target lesion failure compared to small vessels (adjusted HR 0.282, p=0.040).
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