Percutaneous management of long and diffused coronary lesions using newer generation drug-eluting stents in routine clinical practice : long-term outcomes and complication predictors
'Towarzystwo Internistow Polskich/Polish Society of Internal Medicine'
Doi
Abstract
Long and diffuse coronary lesions (LDCLs) are routinely subjected to percutaneous
management, but long‑term
clinical outcomes and complication predictors with the use of contemporary
stents and techniques remain undetermined. Long and diffuse coronary lesion was defined as a lesion requiring an implantation
of 30 mm or longer total stent(s) length (TSL) into one coronary artery (bailouts
excluded). There
were 290 LDCL interventions with the use of newer generation drug‑eluting
stents (DESs cobalt chromium
everolimus- or zotarolimus-eluting stents) performed between January 2013 and January 2016. The mean (SD) TSL was 55.5 (16.8) mm. The use of intravascular ultrasound / optical coherence
tomography was 17.1%, rotablation, 6.9%, and noncompliant balloon, 88.9%. The median (range)
follow‑up
duration was 831 (390-1373) days. All‑cause
mortality and cardiac death rates were 11.7%
and 6.9%, respectively. The myocardial infarction (MI) rate was 6.6%, including target‑vessel
MI in 4.1%.
The rate of clinically‑driven
repeat revascularization was 13.8%, and of definite or probable LDCL stent
thrombosis, 7.2%. Overall patient‑oriented
adverse event rate (any death, MI, or repeat revascularization)
was 25.5%, and device‑oriented
rate (cardiac death, target vessel‑MI,
or target lesion restenosis), 13.4%.
Adverse outcome predictors were chronic kidney disease, acute coronary syndrome as an indication for
the procedure, chronic heart failure with reduced left ventricular ejection fraction, multivessel disease,
and coexisting peripheral artery disease, but not lesion‑related
factors, such as bifurcation, calcification,
chronic total occlusion, or TSL. Adverse outcomes following contemporary LDCL management using newer generation
DESs in routine clinical practice are associated with clinical patient characteristics rather than lesion
characteristics or TSL. We identified high‑risk
patient cohorts that may benefit from enhanced surveillance