Impact of everolimus-eluting stent length on long-term clinical outcomes of percutaneous coronary intervention

Background: Even though longer stented lengths may increase the risk of restenosis, full coverage of diffuse long lesions with longer stents seems to be the optimal strategy for percutaneous coronary intervention (PCI) in the new drug-eluting stent (DES) era. However, it remains unclear whether this strategy will indicate favorable outcome or not. This study evaluated the impact of stent length on twoyear clinical outcomes after PCI with the XIENCE Alpine everolimus-eluting stent. Methods: This was a retrospective, non-randomized, observational study. Four patient groups were classified according to implanted overall total stent length (short, <15 mm; middle,15-23 mm; long, 2432 mm; and ultra-long, >32 mm). The primary outcome of this study was major adverse cardiac events (MACE), defined as the composite of cardiac death, recurrent myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST). Angiographic restenosis by quantitative coronary angiography was defined as >50% diameter stenosis at 10 months after PCI. Results: A total of 730 patients who received intravascular ultrasound (IVUS)-guided PCI were enrolled. The short, middle, long, and ultra-long stent groups included 138 patients (149 lesions), 210 patients (235 lesions), 190 patients (209 lesions), and 192 patients (208 lesions), respectively. The primary outcome at two years did not differ among the four groups (MACE: 4.4% in short, 3.3% in middle, 4.7% in long, and 4.7% in ultra-long groups, p = 0.402); TVR, ST, MI, and cardiac mortality also did not differ among groups. Conclusions: Long stenting using the XIENCE stent which was guided by IVUS for diffuse, long lesions was associated with favorable clinical outcomes at two years in daily clinical practice. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.