Stent Length as Predictor of Target Vessel Revascularization in Patients Treated with Drug-Eluting Stents

Background

While several factors have been shown to increase the risk of stent thrombosis, most cases of target vessel revascularization (TVR) are due to in-stent restenosis (ISR) and have not been fully evaluated.

Objectives

Our aims were to identify predictors of early and late TVR after drug-eluting stents (DES) implantation in a large prospective registry, focusing on stent length.

Methods and results

We analyzed rates of TVR according to stent length in a prospective registry of 14,447 all-comers treated with angioplasty and DES implantation in our institution. Patients were divided into quartiles according to stent length – mean 21mm – percentile 25 (Q1) 15mm, 50 (Q2) 18mm, 75 (Q3) 26mm and 100 (Q4) 32mm. At baseline patients had similar rates of diabetes mellitus, congestive heart failure and left ventricular ejection fraction. Patients in the first quartile tend to be older, more commonly of female gender, with higher rates of GFR<60, anemia and unprotected LM angioplasty. At 4 years follow-up, rates of TVR and MACE were higher in patients with longer stents; 8.5%, 9.8%, 10.4% and 16.1% (p><0.001) and 25.3%, 26.6%, 27% and 28.4% (p=0.031); for TVR and MACE in Q1, Q2, Q3 and Q4 groups of patients; respectively. There were no significant differences in the rates of all-cause death amongst patients in different quartiles. Furthermore, at multivariate Cox-regression analysis length of stent was found to be a significant independent predictor for TVR (OR 1.25 95.0% CI 1.11 – 1.42; p><0.001). >

Conclusion

From the analysis of a large cohort of all-comer angioplasty patients who were treated with DES, stent length emerged as an independent predictor of TVR and MACE.