Key result
Heterogeneous overlapping stents yield similar MACE rates compared to homogeneous stents.
Why the study?
When overlapping stents are required for diffuse coronary artery disease, evidence is inconclusive regarding whether using stents of the same identity yields better outcomes than stents differing in material characteristics.
Does the use of heterogeneous overlapping stents compared to homogeneous overlapping stents reduce major adverse cardiovascular events in patients with diffuse coronary artery disease undergoing PCI?
Cohort (n=935)
Yes
Does the use of heterogeneous overlapping stents compared to homogeneous overlapping stents reduce major adverse cardiovascular events in patients with diffuse coronary artery disease undergoing PCI?
Using heterogeneous overlapping stents yields similar long-term clinical outcomes as homogeneous stents in patients with diffuse coronary artery disease, supporting a 'mix-and-match' strategy when ideal stent pairings are not feasible.
Answers are grounded in this paper and cite their sources.
Heterogeneous overlapping stents were associated with comparable MACE to homogeneous stents; leaves open whether mix-and-match strategies are safe in diffuse CAD.
BACKGROUND AND AIMS: The growing prevalence and severity of diffuse coronary artery disease (dCAD) necessitate the utilization of appropriate stenting techniques to ensure complete target lesion coverage. In clinical settings where overlapping stents are the norm, there is inconclusive evidence to determine whether using stents of the same identity produces better outcomes compared to stents that differ in material characteristics. METHODS AND RESULTS: We conducted a retrospective observational cohort study at two high-volume, tertiary cardiac care centers in India to determine the safety and efficacy of homogeneous overlapping stents (HOSTs) and heterogeneous overlapping stents (HESTs) in patients with dCAD undergoing percutaneous coronary intervention (PCI). Patients were stratified into complex and non-complex subgroups based on pre-specified clinical and angiographic criteria. Out of 12,920 interventions that were performed during the study period (January 2016 to December 2023), 972 procedures utilized overlapping stent strategies, of which 935 cases met the inclusion and exclusion criteria. HOSTs were used in 795 patients, while HESTs were used in 140 patients. To account for imbalances in the study population, inverse probability of treatment weighting (IPTW) was applied following propensity score adjustment via logistic regression modeling. During a mean follow-up of 2.5 years, occurrence of major adverse cardiovascular events (MACE) was comparable between HOST and HEST groups in the unadjusted (odds ratio [OR] 0.91, 95% confidence interval [CI]: 0.59-1.42, p = 0.67), as well as adjusted population (OR 1.05, 95% CI: 0.69-1.61, p = 0.81). Similar trends were observed in the complexity-stratified populations, with no evidence of benefit or harm associated with either stenting strategy. CONCLUSION: Overlapping heterogeneous stents yield similar clinical outcomes as homogeneous stents, regardless of procedural complexity, suggesting that operators may use a "mix-and-match" strategy when ideal stent pairings are not feasible.
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Senguttuvan et al. (2026) conducted a cohort in Diffuse coronary artery disease (dCAD) (n=935). Heterogeneous overlapping stents (HESTs) vs. Homogeneous overlapping stents (HOSTs) was evaluated on Major adverse cardiovascular events (MACE) (OR 1.05, 95% CI 0.69-1.61, p=0.81). Heterogeneous overlapping stents yielded similar rates of major adverse cardiovascular events compared to homogeneous stents (adjusted OR 1.05; 95% CI 0.69-1.61; p=0.81).
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