title: Spot drug-eluting stenting for long coronary stenoses: long-term results of a randomized clinical study.
abstract: BACKGROUND
  Preliminary results of a randomized trial have suggested that total lesion coverage with drug-eluting stents (DES) is not necessary in the presence of diffuse disease of nonuniform severity. In the present study, we report long-term results of this trial.
  
  
  METHODS
  Consecutive, consenting patients with a long (>20 mm) coronary lesion of nonuniform severity and indication for percutaneous coronary intervention were randomized to full stent coverage of the atherosclerotic lesion with multiple, overlapping (full DES group, n = 90) or spot stenting of the hemodynamically significant parts of the lesion only (defined as diameter stenosis > 50%) (spot DES group, n = 89).
  
  
  RESULTS
  At a follow-up of 2-7 years, 30 patients with full DES (33.3%) and 12 patients (13.5%) with spot DES had a major adverse cardiac event (MACE) (P = 0.015). Cox proportional hazard model showed that the risk for MACE was almost 65% lower among patients who were subjected to spot DES compared to those who underwent full DES (HR = 0.35, 95% CI = 0.18-0.68, P = 0.002). This association remained significant even after controlling for age, sex, and lesion length, and the type of stent used (HR = 0.41, 95% CI = 0.20-0.81, P = 0.011).
  
  
  CONCLUSIONS
  In the presence of diffuse disease of nonuniform severity, selective stenting of only the significantly stenosed parts of the lesion confers better long-term results compared to total lesion coverage with DES.
authors: Department of Cardiology, Athens Euroclinic, Athens, Greece. dkatritsis@euroclinic.gr
authors: Demosthenes G
authors: DG
authors: Katritsis
authors: Socrates
authors: S
authors: Korovesis
authors: Efthalia
authors: E
authors: Tzanalaridou
authors: Eleftherios
authors: E
authors: Giazitzoglou
authors: Theodoros
authors: T
authors: Zografos
authors: Bernhard
authors: B
authors: Meier
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D018084:Ultrasonography, Interventional
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin