Jaya Chandrasekhar1, Usman Baber1, Samantha Sartori1, Giulio G Stefanini2, Michele Sarin1, Birgit Vogel1, Serdar Farhan1, Edoardo Camenzind3, Martin B Leon4, Gregg W Stone4, Patrick W Serruys5, William Wijns6, Philippe G Steg7, Giora Weisz8, Alaide Chieffo9, Adnan Kastrati10, Stephan Windecker11, Marie-Claude Morice12, Pieter C Smits13, Clemens von Birgelen14, Ghada W Mikhail5, Dipti Itchhaporia15, Laxmi Mehta16, Hyo-Soo Kim17, Marco Valgimigli18, Raban V Jeger19, Takeshi Kimura20, Søren Galatius21, David Kandzari22, George Dangas1, Roxana Mehran23. 1. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. 2. Humanitas Research Hospital, Rozzano, Milan, Italy. 3. Institut Lorrain du Coeur et des Vaisseaux, Vandoeuvre-lès-Nancy, France. 4. Columbia University Medical Center, New York, New York. 5. Imperial College Healthcare NHS Trust, London, United Kingdom. 6. Cardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium. 7. Département Hospitalo Universitaire, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U114, Paris, France. 8. Columbia University Medical Center, New York, New York; Shaare Zedek Medical Center, Jerusalem, Israel. 9. San Raffaele Scientific Institute, Milan, Italy. 10. Deutsches Herzentrum Munchen, Technische Universitat Munich, Germany. 11. Bern University Hospital, Bern, Switzerland. 12. Institut Cardiovasculaire Paris Sud, Ramsay Générale de Santé, Massy, France. 13. Maasstad Hospital, Rotterdam, the Netherlands. 14. Thoraxcentrum Twente, Enschede, the Netherlands. 15. Hoag Memorial Hospital Presbyterian, Newport Beach, California. 16. Ohio State University Medical Center, Columbus, Ohio. 17. Seoul National University Hospital, Seoul, Korea. 18. University of Ferrara, Ferrara, Italy. 19. University Hospital Basel, Basel, Switzerland. 20. Kyoto University Graduate School of Medicine, Kyoto, Japan. 21. Bispebjerg University Hospital, Copenhagen, Denmark. 22. Piedmont Heart Institute, Atlanta, Georgia. 23. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: roxana.mehran@mountsinai.org.
Abstract
OBJECTIVES: The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES). BACKGROUND: In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear. METHODS: Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, or target lesion revascularization. RESULTS: In the per-patient analysis, a stepwise increase was observed with increasing stent length in the adjusted risk for 3-year MACE (p for trend <0.0001), myocardial infarction (p for trend <0.001), cardiac death (p for trend = 0.038), and target lesion revascularization (p for trend = 0.011) but not definite or probable stent thrombosis (p for trend = 0.673). In the per-lesion analysis, an increase was observed in the adjusted risk for 3-year MACE (p for trend = 0.002) and myocardial infarction (p for trend <0.0001) but not other individual endpoints. On landmark analysis for late event rates between 1 and 3 years, stent length per patient demonstrated weak associations with target lesion revascularization (p = 0.0131) and MACE (p = 0.0499), whereas stent length per lesion was not associated with higher risk for any late events, suggesting that risk was established early within the first year after PCI. CONCLUSIONS: In this pooled analysis of women undergoing PCI with new-generation DES, increasing stent length per patient and per lesion were independent predictors of 3-year MACE but were not associated with definite or probable stent thrombosis.
OBJECTIVES: The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES). BACKGROUND: In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear. METHODS:Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, or target lesion revascularization. RESULTS: In the per-patient analysis, a stepwise increase was observed with increasing stent length in the adjusted risk for 3-year MACE (p for trend <0.0001), myocardial infarction (p for trend <0.001), cardiac death (p for trend = 0.038), and target lesion revascularization (p for trend = 0.011) but not definite or probable stent thrombosis (p for trend = 0.673). In the per-lesion analysis, an increase was observed in the adjusted risk for 3-year MACE (p for trend = 0.002) and myocardial infarction (p for trend <0.0001) but not other individual endpoints. On landmark analysis for late event rates between 1 and 3 years, stent length per patient demonstrated weak associations with target lesion revascularization (p = 0.0131) and MACE (p = 0.0499), whereas stent length per lesion was not associated with higher risk for any late events, suggesting that risk was established early within the first year after PCI. CONCLUSIONS: In this pooled analysis of women undergoing PCI with new-generation DES, increasing stent length per patient and per lesion were independent predictors of 3-year MACE but were not associated with definite or probable stent thrombosis.
Keywords:
new-generation drug-eluting stents; patient-level pooled analysis of women; percutaneous coronary intervention; stent length per lesion; stent length per patient