Impact of stent overlap on long-term clinical outcomes in patients treated with newer-generation drug-eluting stents.
OBJECTIVE
Early-generation drug-eluting stent (DES) overlap (OL) is associated with impaired long-term clinical outcomes whereas the impact of OL with newer-generation DES is unknown. Our aim was to assess the impact of OL on long-term clinical outcomes among patients treated with newer-generation DES.


RESULTS
We analysed the three-year clinical outcomes of 3,133 patients included in a prospective DES registry according to stent type (sirolimus-eluting stents [SES; N=1,532] versus everolimus-eluting stents [EES; N=1,601]), and the presence or absence of OL. The primary outcome was a composite of death, myocardial infarction (MI), and target vessel revascularisation (TVR). The primary endpoint was more common in patients with OL (25.1%) than in those with multiple DES without OL (20.8%, adj HR=1.46, 95% CI: 1.03-2.09) and patients with a single DES (18.8%, adj HR=1.74, 95% CI: 1.34-2.25, p<0.001) at three years. A stratified analysis by stent type showed a higher risk of the primary outcome in SES with OL (28.7%) compared to other SES groups (without OL: 22.6%, p=0.04; single DES: 17.6%, p<0.001), but not between EES with OL (22.3%) and other EES groups (without OL: 18.5%, p=0.30; single DES: 20.4%, p=0.20).


CONCLUSIONS
DES overlap is associated with impaired clinical outcomes during long-term follow-up. Compared with SES, EES provide similar clinical outcomes irrespective of DES overlap status.
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Crochan J
CJ
O'Sullivan
Giulio G
GG
Stefanini
Lorenz
L
Räber
Dik
D
Heg
Masanori
M
Taniwaki
Bindu
B
Kalesan
Thomas
T
Pilgrim
Thomas
T
Zanchin
Aris
A
Moschovitis
Lutz
L
Büllesfeld
Ahmed A
AA
Khattab
Bernhard
B
Meier
Peter
P
Wenaweser
Peter
P
Jüni
Stephan
S
Windecker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023903:Coronary Restenosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D013995:Time; D016896:Treatment Outcome
D000068338:Everolimus; D020123:Sirolimus