Impact of multiple and long sirolimus-eluting stent implantation on 3-year clinical outcomes in the j-Cypher Registry.
OBJECTIVE
Our aim was to study the relationships between total stent length (TSL) and long-term clinical outcomes after sirolimus-eluting stent (SES) implantation.


BACKGROUND
SES compared with bare-metal stent use for long lesion treatment is associated with reduced restenosis rates.


METHODS
Three-year follow-up data were available for 10,773 patients (14,651 lesions) that had been treated with only SES (Cypher, Cordis Corp., Warren, New Jersey) in the j-Cypher registry. Patients and lesions were divided into quartile groups: TSL per patient (Q1: 8 to 23 mm, Q2: 24 to 36 mm, Q3: 37 to 54 mm, Q4: 55 to 293 mm), and TSL per lesion (QA: 8 to 18 mm, QB: 19 to 23 mm, QC: 24 to 33 mm, QD: 34 to 150 mm).


RESULTS
In per-lesion data, longer TSL increased target lesion revascularization (TLR) rates but did not increase stent thrombosis rates (p = 0.2324). In per-patient data, the incidences of TLR remarkably increased with increasing TSL. Incidence of composite of death and myocardial infarction also increased with increasing TSL; however, after adjustment for baseline differences, there was no statistical significance. Definite stent thrombosis rate in group Q4 was significantly higher than in other groups, both unadjusted (hazard ratio: 1.770, p = 0.0081) and adjusted (hazard ratio: 1.727, p = 0.0122) for baseline differences.


CONCLUSIONS
TSL per lesion and patient had significantly impacts on TLR rates. Longer TSL per patient was associated with increased incidence of stent thrombosis through 3 years.
Shirai
Shinichi
S
Division of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
Kimura
Takeshi
T
Nobuyoshi
Masakiyo
M
Morimoto
Takeshi
T
Ando
Kenji
K
Soga
Yoshimitsu
Y
Yamaji
Kyohei
K
Kondo
Katsuhiro
K
Sakai
Koyu
K
Arita
Takeshi
T
Goya
Masahiko
M
Iwabuchi
Masashi
M
Yokoi
Hiroyoshi
H
Nosaka
Hideyuki
H
Mitsudo
Kazuaki
K
D000368:Aged; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000401:mortality / Q000517:prevention & control; D023903:Coronary Restenosis / Q000401:mortality / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007564:Japan; D016015:Logistic Models; D008297:Male; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D020123:Sirolimus