Key result
Treatment of very long coronary lesions (≥60 mm) with overlapping drug-eluting stents resulted in a 23.4% rate of target lesion revascularization at a median follow-up of 39 months.
Why the study?
What are the long-term clinical outcomes and restenosis rates of 'full-metal jacket' percutaneous coronary intervention (≥60 mm continuous drug-eluting stenting) in native coronary arteries?
Cohort (n=617)
Yes
What are the long-term clinical outcomes and restenosis rates of 'full-metal jacket' percutaneous coronary intervention (≥60 mm continuous drug-eluting stenting) in native coronary arteries?
Treatment of very long coronary lesions (≥60 mm) with overlapping drug-eluting stents is associated with a high rate of target lesion revascularization (23.4%) at long-term follow-up, though rates of hard clinical events like cardiac death and stent thrombosis remain relatively low.
Answers are grounded in this paper and cite their sources.
High TLR rates warrant caution with full-metal jacket PCI; leaves open optimal strategies for very long lesions.
BACKGROUND: Limited long-term data exist on patients who have undergone drug-eluting stenting of very long lesions (requiring >or=60 mm of continuous stent) in native coronary arteries ("full-metal jacket"). METHODS AND RESULTS: We examined consecutive procedures taking place between March 2002 and 2007 at 2 high-volume centers in Milan, Italy. Exclusion criteria were percutaneous coronary intervention for restenosis, percutaneous coronary intervention to a bypass graft, or percutaneous coronary intervention for acute ST-elevation myocardial infarction (MI). We identified 658 full-metal jacket lesions in 617 patients. Average age of the cohort was 62.0+/-10.6; 32.8% were diabetic, 51.5% had a previous MI, and 33.4% had undergone a previous percutaneous transluminal coronary angioplasty. Mean ejection fraction was 52.1+/-10.4%. The lesion was a chronic total occlusion in 33.0%. Median duration of clinical follow-up was 39 months (interquartile range, 28 to 50). Six-month follow-up was achieved in 97% of patients; 2-year follow-up was achieved in 91%. All-cause mortality rate was 7.3%; cardiac death rate was 3.6%. Non-procedure-related MI rates were 3.5%. Target lesion revascularization rates were 23.4%. There were 17 cases of Academic Research Consortium-defined definite or probable stent thrombosis (2.6%): 5 acute, 2 subacute, 6 late, and 4 very late. Ten of the 17 cases occurred while the patient was receiving dual antiplatelet therapy; 4 of the 17 after premature termination of 1 or both antiplatelets, and 3 of the 17 occurred while the patient was receiving single-antiplatelet therapy, after having completed the prescribed course of dual antiplatelet therapy. CONCLUSIONS: When very long lesions (>or=60 mm) were treated using overlapping drug-eluting stents, 23.4% required a further procedure for restenosis at 3-year follow-up. However, MI, stent thrombosis, and cardiac mortality rates were relatively low.
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Sharp et al. (2009) conducted a cohort in Very long coronary lesions requiring ≥60 mm of continuous stent (n=617). Drug-eluting stenting of very long lesions (≥60 mm) was evaluated on Target lesion revascularization. Treatment of very long coronary lesions (≥60 mm) with overlapping drug-eluting stents resulted in a 23.4% rate of target lesion revascularization at a median follow-up of 39 months.
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