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CLINICAL STUDIES

Procedural results and late clinical outcomes after percutaneous interventions using long (25 mm) versus short (<20 mm) stents

^a Cardiac Catheterization Laboratory, The Washington Hospital Center, Washington, DC, USA
^b The Cardiovascular Research Foundation, The Washington Hospital Center, Washington, DC, USA

Manuscript received April 21, 1999; revised manuscript received August 16, 1999, accepted November 3, 1999.

Reprint requests and correspondence: Dr. Ran Kornowski, Cardiovascular Research Foundation, Washington Hospital Center, 110 Irving Street, Northwest, Suite 4B-1, Washington, DC 20010
rxk3{at}mhg.edu

OBJECTIVES

To evaluate clinical outcomes after the use of long coronary stents.

BACKGROUND

The use of long slotted-tube stents has been recently approved in the U.S. to treat long lesions or dissections. Procedural success and long-term outcomes of long versus short stents have not been established.

METHODS

We evaluated procedural success, major in-hospital complications, target lesion revascularization and long-term (one year) clinical outcomes in 1,226 consecutive patients (1,259 native coronary lesions) who underwent a single vessel intervention using a single long (25 mm, 116 patients) or short (<20 mm, 1,110 patients) tubular-slotted stent.

RESULTS

Patients treated with long stents had more diffuse (>10 mm length) lesions (63% vs. 28%, p = 0.001). The mean stent length was 28 ± 5 mm versus 15 ± 2 mm for long versus short stent groups (p = 0.001). Overall procedural success was similar in the long versus short stent groups (96% vs. 98%, p = 0.08). However, major in-hospital complications tended to occur more frequently in patients treated with longer stents (3.4% vs. 1.0%, p = 0.04). The rate of periprocedural non-Q-wave myocardial infarction (MI) (creatine kinase-MB 5 times normal) was notably higher after long stent implantation (23% vs. 11%, p = 0.001). Target lesion revascularization at one year was 14.5% vs. 13.8% (p = 0.69), and target vessel revascularization rate was 19.6% vs. 17.3% (p = 0.41) in the long versus short stent group, respectively. There was no difference in one year mortality (2.5% vs. 3.5%, p = 0.49) or Q-wave MI (2.7% vs. 1.2%, p = 0.48), and the overall cardiac event-free survival was similar for the two groups (81%).

CONCLUSIONS

The use of single coronary long (25 mm) versus short (<20 mm) stents is associated with: 1) somewhat increased major procedural complications, 2) significantly higher frequency of periprocedural non-Q-wave MIs, and 3) equivalent repeat revascularization risk and cardiac event-free survival out-of-hospital up to one year.

Abbreviations and Acronyms   CK = creatinine kinase   IVUS = intravascular ultrasound   MB = myocardial band   MI = myocardial infarction   OR = odds ratio   QCA = quantitative coronary angiography   TIMI = thrombolysis in myocardial infarction   TLR = target lesion revascularization   TVR = target vessel revascularization

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