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. 2021 Mar 19;16(16):1318-1325.
doi: 10.4244/EIJ-D-19-00296.

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

Min Gyu Kong  1 , Jung-Kyu Han, Jee-Hoon Kang, Chengbin Zheng, Han-Mo Yang, Kyung Woo Park, Hyun-Jae Kang, Bon-Kwon Koo, In-Ho Chae, Hyo-Soo Kim; Collaborators
Collaborators, Affiliations

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

Min Gyu Kong et al. EuroIntervention. .

Abstract

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 five Korean multicentre DES registries. The median follow-up duration was 730 days (interquartile range 708 to 752 days). A total of 8,035 patients were classified into the short stenting group (≤40 mm), and 1,182 into the long stenting group (>40 mm). The primary endpoint was target lesion failure (TLF). Long stenting (>40 mm) 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 with long stenting during the first 30 days after PCI (log-rank p=0.001) and also after 30 days (log-rank p<0.001). Long stenting was associated with a higher risk of early stent thrombosis (log-rank p=0.001), but not with that of late stent thrombosis (log-rank p=0.887).

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

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Conflict of interest statement

The authors/study collaborators have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Maximally selected rank statistics to determine the optimal cut-off for TLF.
Figure 3
Figure 3
Kaplan-Meier curves of clinical endpoints including target lesion failure (TLF), cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularisation (TLR).
Figure 4
Figure 4
Kaplan-Meier curves of definite or probable stent thrombosis (ST).
Figure 5
Figure 5
Clinical outcomes according to the total stent length divided into three groups. # p<0.05 between ≤20 mm and >40 mm group; * p<0.05 between 20-40 mm and >40 mm group. CD: cardiac death; ST: definite or probable stent thrombosis; TLF: target lesion failure; TLR: clinically driven target lesion revascularisation; TVMI: target vessel myocardial infarction
Figure 6
Figure 6
30-day landmark analysis for target lesion failure (TLF) and definite or probable stent thrombosis (ST).
See this image and copyright information in PMC

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