Key result
DES overlap linked to higher 3-year MACE rates versus non-overlapping or single stents.
Why the study?
Drug-eluting stent overlap has been associated with delayed healing and increased inflammation in experimental studies, but its impact on clinical outcomes was not well established.
Does drug-eluting stent overlap impair angiographic and long-term clinical outcomes in patients undergoing percutaneous coronary intervention?
Observational (n=1,012)
Does drug-eluting stent overlap impair angiographic and long-term clinical outcomes in patients undergoing percutaneous coronary intervention?
Absolute Event Rate: 25.4% vs 21.1%
p-value: p=<0.01
Drug-eluting stent overlap occurs in over 10% of routine PCI patients and is associated with increased angiographic late loss at 8 months and higher rates of major adverse cardiac events, including death or myocardial infarction, at 3 years.
OBJECTIVES We compared the angiographic and long-term clinical outcomes of patients with and without overlap of drug-eluting stents (DES). BACKGROUND DES overlap has been associated with delayed healing and increased inflammation in experimental studies, but its impact on clinical outcome is not well established. METHODS We analyzed the angiographic and clinical outcomes of 1,012 patients treated with DES in the SIRTAX (Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization) trial according to the presence or absence of stent overlap and the number of stents per vessel: 134 (13.2%) patients with multiple DES in a vessel with overlap, 199 (19.7%) patients with multiple DES in a vessel without overlap, and 679 (67.1%) patients with 1 DES per vessel. RESULTS Angiographic follow-up at 8 months showed an increased late loss in DES overlap patients (0.33 +/- 0.61 mm) compared with the other groups (0.18 +/- 0.43 mm and 0.15 +/- 0.38 mm, p < 0.01). The smallest minimal lumen diameter was located at the zone of stent overlap in 17 (68%) of 25 patients with stent overlap who underwent target lesion revascularization. Major adverse cardiac events were more common in patients with DES overlap (34 events, 25.4%) than in the other groups (42 events, 21.1% and 95 events, 14.0%) at 3 years (p < 0.01). Both the risk of target lesion revascularization (20.2% vs. 16.1% vs. 9.7%, p < 0.01) and the composite of death or myocardial infarction (17.2% vs. 14.1% vs. 9.1%, p = 0.01) were increased in patients with DES overlap compared with the other groups. CONCLUSIONS DES overlap occurs in >10% of patients undergoing percutaneous coronary intervention in routine clinical practice and is associated with impaired angiographic and long-term clinical outcome, including death or myocardial infarction. (Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization; NCT00297661).
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Räber et al. (2010) conducted an observational in Coronary artery disease undergoing drug-eluting stent implantation (n=1,012). Multiple drug-eluting stents in a vessel with overlap vs. Multiple DES without overlap and single DES per vessel was evaluated on Major adverse cardiac events at 3 years (p=<0.01). Drug-eluting stent overlap was associated with higher 3-year major adverse cardiac events compared with multiple non-overlapping or single stents (25.4% vs 21.1% vs 14.0%, p<0.01).
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