Procedural results and late clinical outcomes after percutaneous interventions using long (> or = 25 mm) versus short (< 20 mm) stents.
OBJECTIVE
To evaluate clinical outcomes after the use of long coronary stents.


BACKGROUND
The use of long slotted-tube stents has been recently approved in the U.S. to treat long lesions or dissections. Procedural success and long-term outcomes of long versus short stents have not been established.


METHODS
We evaluated procedural success, major in-hospital complications, target lesion revascularization and long-term (one year) clinical outcomes in 1,226 consecutive patients (1,259 native coronary lesions) who underwent a single vessel intervention using a single long (> or =25 mm, 116 patients) or short (<20 mm, 1,110 patients) tubular-slotted stent.


RESULTS
Patients treated with long stents had more diffuse (>10 mm length) lesions (63% vs. 28%, p = 0.001). The mean stent length was 28 +/- 5 mm versus 15 +/- 2 mm for long versus short stent groups (p = 0.001). Overall procedural success was similar in the long versus short stent groups (96% vs. 98%, p = 0.08). However, major in-hospital complications tended to occur more frequently in patients treated with longer stents (3.4% vs. 1.0%, p = 0.04). The rate of periprocedural non-Q-wave myocardial infarction (MI) (creatine kinase-MB > or =5 times normal) was notably higher after long stent implantation (23% vs. 11%, p = 0.001). Target lesion revascularization at one year was 14.5% vs. 13.8% (p = 0.69), and target vessel revascularization rate was 19.6% vs. 17.3% (p = 0.41) in the long versus short stent group, respectively. There was no difference in one year mortality (2.5% vs. 3.5%, p = 0.49) or Q-wave MI (2.7% vs. 1.2%, p = 0.48), and the overall cardiac event-free survival was similar for the two groups (81%).


CONCLUSIONS
The use of single coronary long (> or =25 mm) versus short (<20 mm) stents is associated with: 1) somewhat increased major procedural complications, 2) significantly higher frequency of periprocedural non-Q-wave MIs, and 3) equivalent repeat revascularization risk and cardiac event-free survival out-of-hospital up to one year.
Kornowski
R
R
Cardiac Catheterization Laboratory and The Cardiovascular Research Foundation, The Washington Hospital Center, DC 20010, USA. rxk3@mhg.edu
Bhargava
B
B
Fuchs
S
S
Lansky
A J
AJ
Satler
L F
LF
Pichard
A D
AD
Hong
M K
MK
Kent
K M
KM
Mehran
R
R
Stone
G W
GW
Leon
M B
MB
D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome