Impact of stent overlap on long-term clinical outcomes in patients treated with newer-generation drug-eluting stents

O'Sullivan, Crochan John; Stefanini, Giulio; Räber, Lorenz; Heg, Dik; Taniwaki, Masanori; Kalesan, Bindu; Pilgrim, Thomas; Zanchin, Thomas; Moschovitis, Aris; Büllesfeld, Lutz; Khattab, Ahmed Aziz; Meier, Bernhard; Wenaweser, Peter Martin; Jüni, Peter; Windecker, Stephan (2014). Impact of stent overlap on long-term clinical outcomes in patients treated with newer-generation drug-eluting stents. EuroIntervention, 9(9), pp. 1076-1084. Europa Digital & Publishing 10.4244/EIJV9I9A182

Text O'Sullivan EuroIntervention 2014_p1076.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (3MB) | Request a copy

Aims: Early-generation drug-eluting stent (DES) overlap (OL) is associated with impaired long-term clinical outcomes whereas the impact of OL with newer-generation DES is unknown. Our aim was to assess the impact of OL on long-term clinical outcomes among patients treated with newer-generation DES. Methods and results: We analysed the three-year clinical outcomes of 3,133 patients included in a prospective DES registry according to stent type (sirolimus-eluting stents [SES; N=1,532] versus everolimus-eluting stents [EES; N=1,601]), and the presence or absence of OL. The primary outcome was a composite of death, myocardial infarction (MI), and target vessel revascularisation (TVR). The primary endpoint was more common in patients with OL (25.1%) than in those with multiple DES without OL (20.8%, adj HR=1.46, 95% CI: 1.03-2.09) and patients with a single DES (18.8%, adj HR=1.74, 95% CI: 1.34-2.25, p<0.001) at three years. A stratified analysis by stent type showed a higher risk of the primary outcome in SES with OL (28.7%) compared to other SES groups (without OL: 22.6%, p=0.04; single DES: 17.6%, p<0.001), but not between EES with OL (22.3%) and other EES groups (without OL: 18.5%, p=0.30; single DES: 20.4%, p=0.20). Conclusions: DES overlap is associated with impaired clinical outcomes during long-term follow-up. Compared with SES, EES provide similar clinical outcomes irrespective of DES overlap status.

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