Comparison of everolimus- and sirolimus-eluting stents in patients with long coronary artery lesions: a randomized LONG-DES-III (Percutaneous Treatment of LONG Native Coronary Lesions With Drug-Eluting Stent-III) Trial.
OBJECTIVE
This study compared everolimus-eluting stents (EES) and sirolimus-eluting stents (SES) for long coronary lesions.


BACKGROUND
Outcomes remain relatively unfavorable for stent-based coronary intervention of lesions with long diseased segments.


METHODS
This randomized, multicenter, prospective trial compared the use of long EES with SES in 450 patients with long (≥ 25 mm) native coronary lesions. The primary endpoint of the trial was in-segment late luminal loss at 9-month angiographic follow-up.


RESULTS
The EES and SES groups had similar baseline characteristics. Lesion length was 34.0 ± 15.4 mm in the EES group and 34.3 ± 13.5 mm in the SES group (p = 0.85). Nine-month angiographic follow-up was performed in 80% of the EES group and 81% of the SES group (p = 0.69). In-segment late loss as the primary study endpoint was significantly larger in the EES group than in the SES group (0.17 ± 0.41 mm vs. 0.09 ± 0.30 mm, p for noninferiority = 0.96, p for superiority = 0.04). The in-segment binary restenosis rate was also higher in the EES group than in the SES group (7.3% vs. 2.7%, p = 0.046). However, in-stent late loss (0.22 ± 0.43 mm vs. 0.18 ± 0.28 mm, p = 0.29) and in-stent binary restenosis rate (3.9% vs. 2.7%, p = 0.53) were similar among the 2 groups. The incidence of any clinical outcomes (death, myocardial infarction, stent thrombosis, target lesion revascularization, and composite outcomes) was not statistically different between the 2 groups.


CONCLUSIONS
For patients with long native coronary artery disease, EES implantation was associated with greater angiographic in-segment late loss and higher rates of in-segment restenosis compared with SES implantation. However, clinical outcomes were both excellent and not statistically different.
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Duk-Woo
DW
Park
Young-Hak
YH
Kim
Hae-Geun
HG
Song
Jung-Min
JM
Ahn
Won-Jang
WJ
Kim
Jong-Young
JY
Lee
Soo-Jin
SJ
Kang
Seung-Whan
SW
Lee
Cheol Whan
CW
Lee
Seong-Wook
SW
Park
Sung-Cheol
SC
Yun
Ki-Bae
KB
Seung
Tae-Hyun
TH
Yang
Sang-Gon
SG
Lee
Jae-Hwan
JH
Lee
In-Whan
IW
Seong
Sang-Sig
SS
Cheong
Bong-Ki
BK
Lee
Nae-Hee
NH
Lee
Se-Whan
SW
Lee
Seung-Wook
SW
Lee
Keun
K
Lee
Hyun-Sook
HS
Kim
Doo-Soo
DS
Jeon
Min-Kyu
MK
Kim
Deuk-Young
DY
Nah
Seung-Jea
SJ
Tahk
Seung-Jung
SJ
Park
D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D013223:Statistics as Topic; D013997:Time Factors
D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus