Background Diffuse coronary artery disease (CAD) is a prognostic factor after percutaneous coronary intervention (PCI) and requires multiple overlapping stent implantations. Hypothesis We investigated the impact of ultra‐long 48 mm drug‐eluting stent (DES) on procedural and clinical outcomes in real‐world practice. Methods Patients who underwent DES implantation for a lesion length of >40 mm were selected from a prospective registry between 2019 and 2021. Patients treated with one or more ultra‐long 48 mm DES were in the ultra‐long DES group (n = 221). The others comprised the conventional DES group (n = 428). Procedural and clinical outcomes were compared after propensity score matching (PSM). The primary endpoint was a device‐oriented composite outcome (DOCO) consisting of cardiac death, target vessel‐related myocardial infarction, and target lesion revascularization at 1‐year follow‐up. Results After PSM, 158 matched pairs of patients showed no differences in the baseline clinical and angiographic characteristics. The stent delivery failure rate, the use of guide‐extension catheter or anchor balloon technique, and the procedural success rate were similar for both groups. Approximately two‐thirds of lesions could be treated with one DES in the ultra‐long DES group. At 1‐year follow‐up, the DOCO was similar for both groups (2.5% vs. 0.6%, p = .168). Conclusions In daily clinical practice, ultra‐long DES implantation is as safe and effective as multiple overlapping conventional DES implants in treating diffuse long CAD. However, ultra‐long DES can reduce the number of stents. (Trial Registration: ClinicalTrials.gov Identifier: NCT02038127).
Introduction: The American Heart Association and European Society of cardiology guidelines reclassified heart failure according to left ventricular ejection fraction, recognizing patients with mid-range EF (mrEF; 40% to 49%) as a distinct group. However, studies on the clinical characteristics of mid-range EF patients and the occurrence of cardiovascular events in acute MI patients are insufficient. Methods: We categorized 6,553 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into three groups (reduced EF ; LVEF < 40% at admission, mild-reduced EF ; LVEF 40 to 49%, preserved EF ;LVEF ≥50%). The primary endpoint was defined as any death at two-year. Secondary endpoints were defined as any myocardial infarction, any revascularization, patient-oriented composite outcome(POCE). Results: Compared to patients with other two groups, the reduced EF group had a highest overall mortality, POCE, and any MI (24.7% vs 8.3% vs 4.6%, p < 0.0001, 33.0% vs 15.6% vs 12.4%, p<0.0001, 3.9% vs 2.7% vs 2.6%, p<0.0046). When mid-range EF group was designated as a reference, in multivariate analysis including all variables, significant differences with HFrEF group was found. (Hazard ratio ). When compared with HFpEF, only Model 1 and Model 2 showed a significant statistical difference (Model 1 ; 0.65 (0.53-0.81), Model 2 ; 0.56 (0.56-0.86). Conclusions: Followed up for two years, significant differences in survival rates were observed between the mid-range EF, reduced EF, and preserved EF group. After adjusting for common prognostic factors affecting the overall mortality rate, the reduced EF group had a significantly higher mortality rate than mid-range EF group, but no significant difference was observed between the preserved EF and the mid-range EF group.
Introduction: Current guidelines recommend that patients with peripheral artery disease (PAD) should be treated with antithrombotic agents, renin-angiotensin-system (RAS) blocker, and statin. However, the clinical impact of guideline-directed medical therapy (GDMT) on long-term mortality for newly diagnosed PAD is not clear. Objective: To investigate the prevalence of GDMT and evaluate 5-year mortality according to GDMT after PAD diagnosis. Methods: This retrospective cohort study using a nationwide health insurance claim data in Korea included patients with newly diagnosed with PAD from 2002 to 2015. GDMT was defined as the use of all drugs, including antithrombotic agents, RAS blocker, and statin, within 3 months after PAD diagnosis. The primary endpoint was all-cause mortality. Results: We finally investigate 19,561 patients with newly diagnosed PAD. Among the study population, 4,378 patients (22.4%) were categorized as GDMT and 15,183 patients (77.6%) were non-GDMT. During the 5-year follow-up duration, GDMT showed a lower incidence of all-cause mortality compared to non-GDMT (2.8% vs. 4.8%; hazard ratio [HR], 0.514; 95% confidence interval [CI], 0.424-0.623; p<0.011). Even after propensity matched population, GDMT showed lower mortality rate than non-GDMT (HR 0.283; 95% CI, 0.217-0.370; p<0.001). Among non-GDMT regimens, patients without both RAS blockers and statins had a higher 5-year mortality compared to GDMT (HR 5.324; 95% CI, 3.812-7.438; p<0.001). Conclusions: After PAD diagnosis, GDMT was associated with a lower incidence of mortality. This large-scale retrospective cohort analysis showed insufficient prevalence of GDMT among PAD patients.
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