Impact of stent overlap on angiographic and long-term clinical outcome in patients undergoing drug-eluting stent implantation

Räber, Lorenz; Jüni, Peter; Löffel, Lukas; Wandel, Simon; Cook, Stéphane; Wenaweser, Peter; Togni, Mario; Vogel, Rolf; Seiler, Christian; Eberli, Franz; Lüscher, Thomas; Meier, Bernhard; Windecker, Stephan (2010). Impact of stent overlap on angiographic and long-term clinical outcome in patients undergoing drug-eluting stent implantation. Journal of the American College of Cardiology, 55(12), pp. 1178-1188. New York, N.Y.: Elsevier 10.1016/j.jacc.2009.11.052

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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).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Räber, Lorenz; Wandel, Simon; Cook, Stéphane; Wenaweser, Peter Martin; Togni, Mario; Vogel, Rolf; Seiler, Christian; Meier, Bernhard and Windecker, Stephan

ISSN:

0735-1097

Publisher:

Elsevier

Language:

English

Submitter:

Lorenz Räber

Date Deposited:

04 Oct 2013 14:09

Last Modified:

20 Aug 2015 09:49

Publisher DOI:

10.1016/j.jacc.2009.11.052

PubMed ID:

20298923

Web of Science ID:

000275663200002

Uncontrolled Keywords:

Acute Coronary Syndrome, Aged, Aged, 80 and over, Angina Pectoris, Angioplasty, Balloon, Coronary, Coronary Angiography, Drug-Eluting Stents, Female, Humans, Male, Time Factors, Treatment Outcome

BORIS DOI:

10.7892/boris.1182

URI:

https://boris.unibe.ch/id/eprint/1182 (FactScience: 202146)

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