Long-Term Outcomes of Patients Undergoing Implantation of Long and Short Second-Generation Drug-Eluting Stents

Introduction Despite the introduction of first-generation drug-eluting stents, lesion length has remained a predictor of target lesion revascularization. To address this limitation, stents with thinner struts, more advanced polymers, and drugs with more controlled release were developed. However, the impact of second-generation drug-eluting stent (DES2) length on clinical outcomes remains uncertain. Objective The objective of this study was to evaluate the impact of DES2 length on long-term safety and efficacy by comparing outcomes between patients who underwent implantation of long and short DES2. Methods This observational, retrospective, non-randomized, single-center study included all patients who received only DES2 from January 1, 2011, to December 31, 2017. Patients were divided into two groups based on the length of the implanted DES2: 1) long stent group (LSG) with at least one stent measuring 30 mm or longer, and 2) short stent group (SSG) with one or more stents measuring 20 mm or shorter without overlap. The primary endpoint was target lesion failure (TLF) during a three-year follow-up period. Results A total of 278 patients were assigned to the SSG (mean stent length: 19.32±8.6 mm), while 436 patients were assigned to the LSG (mean stent length: 55.38±23.3 mm). The LSG showed a significantly higher incidence of TLF: 16.7% versus 10.4% [SHR (95%CI): 1.78 (1.15-2.76), p=0.01]. No significant differences were observed in the secondary endpoints. Conclusion Despite technological advances, the use of DES2 measuring 30 mm or longer has been associated with a higher TLF rate. Therefore, the implantation of longer DES2, compared with DES2 measuring 20 mm or shorter, significantly impacted long-term clinical outcomes related to TLF, while secondary outcomes were not affected.