Key result
Ultra-long 48 mm DES shows similar 1-year device-oriented outcomes compared to overlapping conventional stents.
Why the study?
Diffuse coronary artery disease requires multiple overlapping stents and impacts post-PCI prognosis, prompting evaluation of the real-world procedural and clinical impact of ultra-long 48 mm drug-eluting stents.
Does ultra-long 48 mm DES improve procedural and clinical outcomes compared to multiple overlapping conventional DES in patients with diffuse long coronary artery disease?
Observational (n=649)
Yes
Does ultra-long 48 mm DES improve procedural and clinical outcomes compared to multiple overlapping conventional DES in patients with diffuse long coronary artery disease?
Absolute Event Rate: 0.6% vs 2.5%
p-value: p=0.168
In real-world practice, ultra-long 48 mm DES implantation is as safe and effective as multiple overlapping conventional DES for diffuse long coronary artery disease, while reducing the number of stents and contrast volume.
May reduce stent number in diffuse CAD; leaves open randomized confirmation before practice change.
BACKGROUND: Diffuse coronary artery disease (CAD) is a prognostic factor after percutaneous coronary intervention (PCI) and requires multiple overlapping stent implantations. HYPOTHESIS: We investigated the impact of ultra-long 48 mm drug-eluting stent (DES) on procedural and clinical outcomes in real-world practice. METHODS: Patients who underwent DES implantation for a lesion length of >40 mm were selected from a prospective registry between 2019 and 2021. Patients treated with one or more ultra-long 48 mm DES were in the ultra-long DES group (n = 221). The others comprised the conventional DES group (n = 428). Procedural and clinical outcomes were compared after propensity score matching (PSM). The primary endpoint was a device-oriented composite outcome (DOCO) consisting of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization at 1-year follow-up. RESULTS: After PSM, 158 matched pairs of patients showed no differences in the baseline clinical and angiographic characteristics. The stent delivery failure rate, the use of guide-extension catheter or anchor balloon technique, and the procedural success rate were similar for both groups. Approximately two-thirds of lesions could be treated with one DES in the ultra-long DES group. At 1-year follow-up, the DOCO was similar for both groups (2.5% vs. 0.6%, p = .168). CONCLUSIONS: In daily clinical practice, ultra-long DES implantation is as safe and effective as multiple overlapping conventional DES implants in treating diffuse long CAD. However, ultra-long DES can reduce the number of stents. (Trial Registration: ClinicalTrials.gov Identifier: NCT02038127).
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Youn et al. (2023) conducted an observational in Diffuse long coronary artery disease (n=649). Ultra-long 48 mm drug-eluting stent vs. Multiple overlapping conventional drug-eluting stents was evaluated on Device-oriented composite outcome (DOCO) consisting of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization at 1-year follow-up (p=0.168). Ultra-long 48 mm drug-eluting stent implantation resulted in a similar 1-year rate of device-oriented composite outcomes compared to multiple overlapping conventional stents (0.6% vs 2.5%, p=0.168).
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