title: Long-term (8 year) outcomes and predictors of major adverse cardiac events after full metal jacket drug-eluting stent implantation.
abstract: OBJECTIVE
  We examined long-term outcomes and predictors of major adverse cardiac events after the full metal jacket (FMJ) stent implantation.
  
  
  BACKGROUND
  The FMJ procedure has been used to treat diffuse coronary artery disease (CAD), but long-term outcomes remain unknown.
  
  
  METHODS
  The study population consisted of 347 consecutive patients (352 lesions) who had been treated for de novo diffuse CAD with FMJ stents (stent length ≥ 60 mm).
  
  
  RESULTS
  The mean age was 61.0 ± 10.1 years, and the stent length was 71.9 ± 13.7 mm. The procedural success rate was 97.7%. Major in-hospital complications (one death and two acute stent thromboses) occurred in three patients (0.7%). The median follow-up was 101 months (interquartile range, 95-108 months). During follow-up, there were 60 deaths (33 cardiac), 20 myocardial infarctions, and 94 revascularizations. Definite stent thrombosis occurred in 12 patients. The event-free survival rate for cardiac death, cardiac death/myocardial infarction, or cardiac death/myocardial infarction/target lesion revascularization was 90.5 ± 1.6, 85.8 ± 1.9, and 71.6 ± 2.5% at 8 years, respectively. Left ventricular dysfunction (ejection fraction < 45%) was an independent predictor of cardiac death (OR: 4.88; 95% CI: 1.81-13.13; P = 0.002). Left ventricular dysfunction and a stent length > 80 mm were significantly related to cardiac death/myocardial infarction. Likewise, a stent length > 80 mm was an independent predictor of cardiac death/myocardial infarction/target lesion revascularization (OR: 2.45; 95% CI: 1.16-5.19; P = 0.019).
  
  
  CONCLUSIONS
  Long-term outcomes appear favorable after FMJ procedures, and left ventricular dysfunction and a stent length > 80 mm are major predictors of major adverse cardiac events. These findings might be useful in identifying the most suitable treatments for patients with very diffuse CAD. © 2013 Wiley Periodicals, Inc.
authors.affiliation: Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors.forename: Cheol Whan
authors.initials: CW
authors.lastname: Lee
authors.forename: Jung-Min
authors.initials: JM
authors.lastname: Ahn
authors.forename: Jong-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Won-Jang
authors.initials: WJ
authors.lastname: Kim
authors.forename: Duk-Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Seung-Whan
authors.initials: SW
authors.lastname: Lee
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Seong-Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011379:Prognosis; D011474:Prosthesis Design; D056910:Republic of Korea / Q000453:epidemiology; D013997:Time Factors
keywords: diffuse coronary lesion; full metal jacket stents; long-term outcomes