The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Clinical outcomes of long stent in the drug-eluting stent era: patient-level pooled analysis from the GRAND-DES registry

DOI: 10.4244/EIJ-D-19-00296

1. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
2. Cardiovascular Center, Seol National University Hospital, Seoul, Republic of Korea, Korea, Republic Of
3. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
4. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
5. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
6. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
7. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
8. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
9. Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
10. Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
11. Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon
12. Department of Cardiology, Ulsan Medical Center, Ulsan Hospital, Ulsan
13. Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju
14. Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan
15. Department of Internal Medicine, Haeundae Paik Hospital, Inje University college of Medicine, Busan
16. Cardiovascular Center, Korea University Guro Hospital, Seoul
17. Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang
18. Department of Internal Medicine and Cardiovascular Center, Presbyterian Medical Center, Jeonju
19. Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon
20. Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan
21. Division of Cardiology, Department of Internal Medicine, Chungnam National University School of Medicine, Daejon
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Aims: We aimed to understand the association between stent length and clinical outcomes after percutaneous coronary intervention (PCI) using newer generation drug-eluting stents (DES). 

Methods and results: We analysed 9,217 patients who underwent stenting for a single lesion, from the GRAND-DES registry, a patient-level pooled registry including 5 Korean multicenter DES registries. The median follow-up duration was 730 days (interquartile range 708 to 752 days). 8,035 patients were classified under the short stent group (≤40mm), and 1,182 under the long stent group (>40mm). The primary endpoint was target lesion failure (TLF). Long stent (>40mm) was significantly associated with higher TLF (IPTW adjusted HR:1.88, 95% CI:1.67-2.13; p<0.001), and definite or probable stent thrombosis (IPTW adjusted HR:2.20, 95% CI:1.51-3.20; p<0.001). In the landmark analysis, the incidence of TLF was significantly higher in long stent during the first 30 days after PCI (log-rank p=0.001), and also after 30 days (log-rank p<0.001). Long stent was associated with a higher risk of early stent thrombosis (log-rank p=0.001), but not with that for late stent thrombosis (log-rank p=0.887). 

Conclusions:In the contemporary 2nd generation DES era, stenting longer than 40mm continues to be associated with less favourable clinical outcomes such as TLF, and stent thrombosis.

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