title: Impact of ultra-long second-generation drug-eluting stent implantation.
abstract: OBJECTIVE
  This study investigated the safety and prognosis of ultra-long second DES (UL-2nd DES) implantation in real-world practice.
  
  
  BACKGROUND
  Long stenting is a widely known predictor of stent thrombosis (ST) or target lesion revascularization (TLR) in first-generation drug-eluting stents (DES).
  
  
  METHODS
  Participants were 1,669 patients (2,763 lesions) who had undergone successful second DES implantation; they were assigned to one of three groups: ultra-long 2nd DES (UL-DES; >50 mm, 166 patients, 259 lesions), long second DES (L-DES; 20-50 mm, 758 patients, 1,212 lesions), or short second DES (S-DES; <20 mm, 745 patients, 1,292 lesions). The primary endpoint was TLR, and secondary endpoints were ST, cardiac death, and major adverse cardiac events (MACE; composite of TLR, ST and cardiac death). A Cox proportional hazards model was used to identify independent predictors of TLR.
  
  
  RESULTS
  Patient characteristics including dual antiplatelet therapy duration were similar across groups. Follow-up data were obtained from hospital charts, by contacting patients. Target lesion characteristics in the UL-DES group showed higher right coronary artery and chronic total occlusion lesion rates. TLR rates (23.1 ± 13.2 months) were significantly higher in the UL-DES group relative to other groups during follow up (P < 0.001). TLR rate was similar between S-DES and L-DES (P = 0.30). The incidence of ST was similar across groups (P = 0.40). MACE was significantly higher in the UL-DES group relative to other groups due to higher TLR rates (P = 0.01). In a Cox proportional hazard model, hemodialysis (RR: 2.53, 95% CI: 1.69-3.67, P < 0.001) and total stent length of >50 mm (RR: 1.67, 95% CI: 1.07-2.55, P = 0.02) were independent predictors of TLR.
  
  
  CONCLUSIONS
  Ultra-long DES implantation was associated with higher TLR rates but did not increase ST, while long DES implantation up to 50 mm was safe and acceptable.
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Honda
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamawaki
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Motoharu
authors.initials: M
authors.lastname: Araki
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takimura
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Mouri
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tsutumi
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Takama
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Takafuji
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tokuda
authors.affiliation: Saiseikai Yokohama City Eastern Hospital, Yokohama City, Kanagawa, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Makino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D023903:Coronary Restenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: second-generation DES; stent thrombosis; target lesion revascularization; ultra-long stenting