Background Drug-eluting stents (DSE) markedly reduce the rate of in stent restenosis, but limited data exists as to the long-term outcome in patients with long coronary lesions (≥40 mm) undergoing multiple overlapping DES implantation of in native coronary vessels.

Methods A total of 11073 consecutive patients undergoing percutaneous coronary intervention (PCI) with drug eluting stent were retrospectively were screened. Interventions for in stent restenosis, bypass graft, and primary PCI were excluded. All other patients (n=1411) receiving ≥2 overlapping drug-eluting stents and total stent length in target lesion ≥40 mm for de novo coronary arteries were retrospectively analysed. The clinical outcomes of those patients were compared with consecutive patients with multiple drug-eluting stents implantation but without overlapping stents. An age-matched (±5 years) control group with the same total number of stents and similar total stent length (±10 mm) in target vessel was collected from the total population undergoing PCI with DES during the same study period. Patients were followed up either by telephone or by visiting outpatient clinic.

Results Successfully matching and complete clinical follow-up was achieved in 522 pairs. Median clinical follow-up duration was 35.0 months (IQR 24.3–46.4); Mean total length and number of stents in target vessel was 65.2±24.4 mm and 2.4±0.7, respectively. Nineteen percent lesions in the overall cohort were chronic total occlusions and 9% involved left main or bifurcation lesions. Patients with overlapping DSE stints were associated with significantly increased overall major adverse cardiac event rate (MACE) (18.4% vs 11.9%, p=0.004), which was largely driven by significantly higher incidence of target vessel revascularisation (8.8% vs 5.2%, p=0.028). Whereas all cause mortality (5.2% vs 4.2%, p=0.559), myocardial infarction (5.0% vs 4.0%, p=0.551) and ARC defined definite or probable stent thrombosis rates (2.3% vs 1.5%, p=0.499) were comparable in patients with or without overlapping DES.

Conclusion Coronary stenting for long lesions (≥40 mm) using overlapping drug-eluting stents presented in over 12% of patients undergoing PCI in routine clinical practice and was associated with acceptable clinical outcome during median 35.0 months follow-up.