title: Long-Term Predictors of Clinical Events after Off-Label Use of Drug-Eluting Stent beyond 1 Year.
abstract: OBJECTIVE
  We evaluated the long-term outcomes and predictors of clinical events after off-label use of drug-eluting stents (DES) beyond 1 year after procedure.
  
  
  METHODS
  A total of 518 patients who underwent DES implantation for off-label indications and did not have any major adverse cardiac events (MACE) during the first year were analyzed. The occurrence of MACE, including cardiac death, myocardial infarction (MI), stent thrombosis and target vessel revascularization, were evaluated for a median 1179 days (interquartile range 769-1541) after the first year.
  
  
  RESULTS
  Major adverse cardiac events occurred in 43 patients (8.3%) including 8 cases (1.5%) of cardiac death, 9 cases (1.7%) of MI, 24 cases (4.6%) of target vessel revascularization, and 11 cases (2.1%) of stent thrombosis. Patients with MACE had a higher serum creatinine level, higher incidence of in-stent restenosis lesion, more overlapping stents, a greater number of stents, and longer stents than did patients without MACE. Multivariate analysis revealed that serum creatinine level >1.5 mg/dL {hazard ratio (HR) 2.3, p=0.019}, stent length >33 mm (HR 2.4, p=0.035), and in-stent restenosis lesions (HR 2.4, p=0.040) were independent risk factors for MACE. Patients with DES length >33 mm had a higher incidence of MACE than those with DES length ≤33 mm (HR 2.7, log rank p=0.002).
  
  
  CONCLUSIONS
  The risk of stent thrombosis and target vessel revascularization persisted in patients undergoing off-label DES implantation beyond 1-year follow-up. A total DES length >33 mm was a significant procedural predictor associated with the incidence of MACE.
authors.affiliation: Department of Cardiovascular Medicine, Regional Cardiovascular Center, Wonkwang University Hospital, Iksan, Korea.
authors.forename: Kyeong Ho
authors.initials: KH
authors.lastname: Yun
authors.forename: Jum Suk
authors.initials: JS
authors.lastname: Ko
authors.forename: Sang Jae
authors.initials: SJ
authors.lastname: Rhee
authors.forename: Eun Mi
authors.initials: EM
authors.lastname: Lee
authors.forename: Nam Jin
authors.initials: NJ
authors.lastname: Yoo
authors.forename: Nam-Ho
authors.initials: NH
authors.lastname: Kim
authors.forename: Seok Kyu
authors.initials: SK
authors.lastname: Oh
authors.forename: Jin-Won
authors.initials: JW
authors.lastname: Jeong
keywords: Angioplasty; Coronary thrombosis; Drug-eluting stents; Treatment outcome