Xiang Chen1,2, Xiaofei Gao1, Jing Kan1, Rajiv Shrestha1, Leng Han3, Shu Lu4, Xuesong Qian5,6, Bill D Gogas5,6, Junjie Zhang7, Shao-Liang Chen8. 1. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68#, Nanjing, 210006, China. 2. Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Jinshan Road 2999#, Xiamen, China. 3. Department of Cardiology, Changshu NO.1 People's Hospital, Changshu, China. 4. Department of Cardiology, The First People's Hospital of Taicang, Taicang, China. 5. Department of Cardiology, The First People's Hospital of Zhangjiagang, Zhangjiagang, China. 6. Department of Cardiology, Emory University Hospital, Atlanta, GA, USA. 7. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68#, Nanjing, 210006, China. jameszll@163.com. 8. Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68#, Nanjing, 210006, China. chmengx@126.com.
Abstract
PURPOSE: This study was to analyze the incidence of definite stent thrombosis (ST) after the implantation of drug-eluting stents (DESs) and cutoff value of overlapping length for predicting definite ST. An overlapping stent is associated with a high rate of clinical events after DES implantation compared with a non-overlapping stent. However, the rates of definite ST and clinical outcomes from a large patient population remain underreported. METHODS: A total of 15,561 patients with 24,183 lesions who underwent DES implantation from January 2005 to February 2017 were retrospectively included in 5 tertiary hospitals in China. The main endpoint was the incidence of definite ST after procedures. RESULTS: With a median of 1932 (IQR = 1194-2929) days, clinical follow-up was available in 7484 patients in the overlap group and in 8077 patients in the non-overlap group. The rates of definite ST were 3.1% in the overlap group and 1.2% in the non-overlap group (HR: 2.67 (95% CI: 2.11-3.38), p < 0.001). Of the 24,183 treated lesions, the incidences of definite ST were 2.4% in the overlap group and 0.9% in the non-overlap group (HR: 2.96 (95% CI: 2.38-3.69), p < 0.001). Stent overlap was associated with a higher rate of target lesion revascularization (TLR) (9.4%) compared with stent non-overlap (6.4%, p < 0.001). The length of overlapping stent ≥ 2.93 mm strongly correlated with definite ST. CONCLUSION: The present study shows that overlapping DES increases definite ST and revascularization in patients during long-term follow-up. In addition, the longer overlapping zone was associated with worse clinical outcomes.
PURPOSE: This study was to analyze the incidence of definite stent thrombosis (ST) after the implantation of drug-eluting stents (DESs) and cutoff value of overlapping length for predicting definite ST. An overlapping stent is associated with a high rate of clinical events after DES implantation compared with a non-overlapping stent. However, the rates of definite ST and clinical outcomes from a large patient population remain underreported. METHODS: A total of 15,561 patients with 24,183 lesions who underwent DES implantation from January 2005 to February 2017 were retrospectively included in 5 tertiary hospitals in China. The main endpoint was the incidence of definite ST after procedures. RESULTS: With a median of 1932 (IQR = 1194-2929) days, clinical follow-up was available in 7484 patients in the overlap group and in 8077 patients in the non-overlap group. The rates of definite ST were 3.1% in the overlap group and 1.2% in the non-overlap group (HR: 2.67 (95% CI: 2.11-3.38), p < 0.001). Of the 24,183 treated lesions, the incidences of definite ST were 2.4% in the overlap group and 0.9% in the non-overlap group (HR: 2.96 (95% CI: 2.38-3.69), p < 0.001). Stent overlap was associated with a higher rate of target lesion revascularization (TLR) (9.4%) compared with stent non-overlap (6.4%, p < 0.001). The length of overlapping stent ≥ 2.93 mm strongly correlated with definite ST. CONCLUSION: The present study shows that overlapping DES increases definite ST and revascularization in patients during long-term follow-up. In addition, the longer overlapping zone was associated with worse clinical outcomes.
Authors: Vikas Thondapu; Christos V Bourantas; Nicolas Foin; Ik-Kyung Jang; Patrick W Serruys; Peter Barlis Journal: Eur Heart J Date: 2017-01-07 Impact factor: 29.983