Registro de lesiones coronarias difusas tratadas con stents liberadores de fármacos ≥ 40 mm

Introduction

Long lesions present special challenges for interventional cardiologists, including increased risk of restenosis and complications. We assessed the clinical outcome of real-world patients treated with ≥40 mm drug-eluting stents (DES).

Methods

Prospective observational study of consecutive patients with a very long coronary lesion (> 35 mm) treated by percutaneous coronary intervention with one implanted Xience Xpedition (Abbott Vascular) everolimus-eluting stent (EES) and Biomime (Palex Medical) sirolimus-eluting stent (SES) ≥40 mm. We collected major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction and target lesion revascularization (TLR).

Results

94 real-world patients with 113 lesions (80% male, 63.8 ± 10 years, 55% smoker, 77% hypertensive, 41.5% diabetic, 58% hyperlipidemic) were enrolled in the study. Clinical presentation was acute coronary syndrome in 80%. Bifurcation lesions account 44%, ostial 32%, calcified 87%, thrombotic 20.6% and 22.7% were CTO. Mean lesion length was 57.9 ± 19 mm, and mean stent length was 46 ± 2.5 mm, with overlapped stents in 59%. The total length (in mm) of stent per lesion was 64 ± 21 mm. 47 EES were implanted in 45 patients and 45 SES in 35 patients. At 14.8 ± 11 month follow-up, 4 (4.3%) patients had died from cardiac causes, 2 (2.1%) had a nonfatal myocardial infarction and 3 (3.2%) underwent TLR. One patient had a subacute stent thrombosis (2 overlapped SES stents = 1.1%). The cumulative rate of MACE was 9.6%.

Conclusions

Patients with complex very long coronary lesions in a real-world population treated with long DES (≥40 mm) are associated with excellent procedural results and good clinical outcomes at long term follow-up.