title: Impact of stent overlapping on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction: insights from the five-year follow-up of the EXAMINATION trial.
abstract: OBJECTIVE
  The aim of this study was to compare the long-term outcomes of STEMI patients treated with overlap vs. no-overlap stents.
  
  
  RESULTS
  We analysed the one- and five-year clinical outcomes of 1,498 STEMI patients according to overlapping stent implantation. The primary endpoint was a patient-oriented composite endpoint (PoCE) of all-cause death, myocardial infarction, and repeat revascularisation. Stent thrombosis data were also analysed. Four hundred and four (27.0%) patients were treated with overlapping stents, whereas the remaining 1,094 (73.0%) were not. At one and five years, there was no difference in PoCE between the overlap vs. no-overlap group, even after adjustment (14.9% vs. 12.4%; HR 1.20, 95% CI: 0.76-1.90; p=0.44, and 26.3% vs. 22.3%; HR 1.14, 95% CI: 0.80-1.62; p=0.47, respectively). At five years, within the overlap group, patients who received BMS had a trend towards a higher rate of PoCE and DoCE as compared to those who received EES. At one year, there was a trend towards a higher rate of definite/probable stent thrombosis in the overlap compared to the no-overlap group (2.2% vs. 1.6%; HR 2.35, 95% CI: 0.95-5.90; p=0.06). This difference was driven by a higher rate for BMS compared to EES (4.4% vs. 0%, p for interaction=0.03) in the overlap group. At five years, the absolute risk difference for overlap (3.5% vs. 2.2%, p=0.99) and interaction for BMS (p=0.03) were similar.
  
  
  CONCLUSIONS
  In patients presenting with STEMI, the long-term PoCE was similar for the overlap and no-overlap groups. Overlap among patients receiving BMS appears to be associated with a higher risk for adverse cardiovascular outcomes and stent thrombosis.
authors.affiliation: Cardiovascular Institute, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Ortega-Paz
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giacchi
authors.forename: Kohki
authors.initials: K
authors.lastname: Ishida
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.forename: Andrés
authors.initials: A
authors.lastname: Iñiguez
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.forename: Pilar
authors.initials: P
authors.lastname: Jiménez-Quevedo
authors.forename: Vicente
authors.initials: V
authors.lastname: Mainar
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Tespili
authors.forename: Peter
authors.initials: P
authors.lastname: den Heijer
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003328:Coronary Thrombosis / Q000188:drug therapy; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D020123:Sirolimus / Q000627:therapeutic use; D013995:Time; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus