Impact of stent overlap on angiographic and long-term clinical outcome in patients undergoing drug-eluting stent implantation

Lorenz Räber; Peter Jüni; Lukas Löffel; Simon Wandel; Stéphane Cook; Peter Wenaweser; Mario Togni; Rolf Vogel; Christian Seiler; Franz Eberli; Thomas Lüscher; Bernhard Meier; Stephan Windecker

doi:10.1016/j.jacc.2009.11.052

Impact of stent overlap on angiographic and long-term clinical outcome in patients undergoing drug-eluting stent implantation

J Am Coll Cardiol. 2010 Mar 23;55(12):1178-1188. doi: 10.1016/j.jacc.2009.11.052.

Authors

Affiliations

¹ Department of Cardiology, Bern University Hospital, Bern, Switzerland.
² Clinical Trials Unit, Bern University Hospital, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
³ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
⁴ Department of Cardiology, Triemlispital, Zurich University Hospital, Zurich, Switzerland.
⁵ Cardiology, University Hospital Zurich, Zurich, Switzerland.
⁶ Department of Cardiology, Bern University Hospital, Bern, Switzerland; Clinical Trials Unit, Bern University Hospital, Bern, Switzerland. Electronic address: stephan.windecker@insel.ch.

PMID: 20298923
DOI: 10.1016/j.jacc.2009.11.052

Abstract

Objectives: We compared the angiographic and long-term clinical outcomes of patients with and without overlap of drug-eluting stents (DES).

Background: DES overlap has been associated with delayed healing and increased inflammation in experimental studies, but its impact on clinical outcome is not well established.

Methods: We analyzed the angiographic and clinical outcomes of 1,012 patients treated with DES in the SIRTAX (Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization) trial according to the presence or absence of stent overlap and the number of stents per vessel: 134 (13.2%) patients with multiple DES in a vessel with overlap, 199 (19.7%) patients with multiple DES in a vessel without overlap, and 679 (67.1%) patients with 1 DES per vessel.

Results: Angiographic follow-up at 8 months showed an increased late loss in DES overlap patients (0.33 +/- 0.61 mm) compared with the other groups (0.18 +/- 0.43 mm and 0.15 +/- 0.38 mm, p < 0.01). The smallest minimal lumen diameter was located at the zone of stent overlap in 17 (68%) of 25 patients with stent overlap who underwent target lesion revascularization. Major adverse cardiac events were more common in patients with DES overlap (34 events, 25.4%) than in the other groups (42 events, 21.1% and 95 events, 14.0%) at 3 years (p < 0.01). Both the risk of target lesion revascularization (20.2% vs. 16.1% vs. 9.7%, p < 0.01) and the composite of death or myocardial infarction (17.2% vs. 14.1% vs. 9.1%, p = 0.01) were increased in patients with DES overlap compared with the other groups.

Conclusions: DES overlap occurs in >10% of patients undergoing percutaneous coronary intervention in routine clinical practice and is associated with impaired angiographic and long-term clinical outcome, including death or myocardial infarction. (Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization; NCT00297661).

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome / therapy*
Aged
Aged, 80 and over
Angina Pectoris / therapy*
Angioplasty, Balloon, Coronary*
Coronary Angiography
Drug-Eluting Stents*
Female
Humans
Male
Time Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT00297661