Comparison of full lesion coverage versus spot drug-eluting stent implantation for coronary artery stenoses.
OBJECTIVE
The aim of this study was to evaluate and compare the long-term clinical outcomes of the spot drug-eluting stent (DES) implantation strategy, which is used to minimize implanted stent length and the number of stents, versus full lesion coverage for treatment of coronary artery stenoses.


METHODS
We evaluated 1-year clinical outcomes of 1619 patients with stent implantation for a single coronary lesion. They were divided into two groups: those treated by full lesion coverage (n=1200) and those treated with the spot stenting strategy (n=419). The combined occurrence of 1-year target vessel failure (TVF), including cardiac death, target-vessel related myocardial infarction, or ischemia-driven target-vessel revascularization was evaluated.


RESULTS
The spot DES implantation group had a shorter stent length (23.14±9.70 mm vs. 25.44±13.24 mm, respectively; p<0.001) and a fewer number of stents (1.09±0.30 vs. 1.16±0.41, respectively; p<0.001), even though the average lesion length was similar to the full lesion coverage group (21.36±10.30 mm vs. 20.58±10.97 mm, respectively; p=0.206). Spot DES implantation was superior to full DES coverage with respect to 1-year TVF (1.4% vs. 3.3%, p=0.044). Cox proportional hazard model analysis showed that the risk for 1-year TVF was almost 60% lower among patients who received spot DESs compared to those who received full DES coverage after adjustment for other risk factors (HR=0.40, 95% confidence interval=0.17-0.98; p=0.046).


CONCLUSIONS
Minimizing stent length and the number of stents with overlapping by spot DES implantation may result in reduced rates of 1-year TVF, compared with full DES coverage.
Department of Cardiology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.
Seunghwan
S
Kim
Department of Cardiovascular Medicine, Regional Cardiovascular Center, Wonkwang University Hospital, Iksan, Korea.
Kyeong Ho
KH
Yun
Department of Cardiology, Gil Hospital, Gachon University, Incheon, Korea.
Woong Chol
WC
Kang
Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Dong-Ho
DH
Shin
Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Jung-Sun
JS
Kim
Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Byeong-Keuk
BK
Kim
Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Young-Guk
YG
Ko
Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Donghoon
D
Choi
Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. ; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Yangsoo
Y
Jang
Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. ; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Myeong-Ki
MK
Hong
D000368:Aged; D023921:Coronary Stenosis / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*
Drug-eluting stents; coronary artery disease; percutaneous coronary intervention