Clinical outcomes of long stenting in the drug-eluting stent era: patient-level pooled analysis from the GRAND-DES registry

Kong, Min Gyu; Han, Jung Kyu; Kang, Jee Hoon; Zheng, Chengbin; Yang, Han Mo; Park, Kyung Woo; Kang, Hyun Jae; Koo, Bon Kwon; Chae, In Ho; Kim, Hyo Soo

doi:10.4244/eij-d-19-00296

Cited by 24 publications

(21 citation statements)

References 19 publications

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“…1). The individual trial designs and primary results have been published previously [4][5][6]. Each trial included in this analysis complied with the Declaration of Helsinki, and the study protocols were approved by the Institutional Review Board at each participating center.…”

Section: Methodsmentioning

confidence: 99%

Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry

et al. 2023

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Background:The contribution of sex and initial clinical presentation to the long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) is still debated.Methods: Individual patient data from 5 Korean-multicenter drug-eluting stent (DES) registries (The GRAND-DES) were pooled. A total of 17,286 patients completed 3-year follow-up (5216 women and 12,070 men). The median follow-up duration was 1125 days (interquartile range 1097-1140 days), and the primary endpoint was cardiac death at 3 years. Results:The clinical indication for PCI was stable angina pectoris (SAP) in 36.8%, unstable angina pectoris (UAP) or non-ST-segment elevation myocardial infarction (NSTEMI) in 47.4%, and STEMI in 15.8%. In all groups, women were older and had a higher proportion of hypertension and diabetes mellitus compared with men. Women presenting with STEMI were older than women with SAP, with the opposite seen in men. There was no sex difference in cardiac death for SAP or UAP/NSTEMI. In STEMI patients, the incidence of cardiac death (7.9% vs. 4.4%, p = 0.001), all-cause mortality (11.1% vs. 6.9%, p = 0.001), and minor bleeding (2.2% vs. 1.2%, p = 0.043) was significantly higher in women. After multivariable adjustment, cardiac death was lower in women for UAP/NSTEMI (HR 0.69, 95% CI 0.53-0.89, p = 0.005), while it was similar for STEMI (HR 0.97, 95% CI 0.65-1.44, p = 0.884). Conclusions:There was no sex difference in cardiac death after PCI with DES for SAP and UAP/NSTEMI patients. In STEMI patients, women had worse outcomes compared with men; however, after the adjustment of confounders, female sex was not an independent predictor of mortality.

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Section: Methodsmentioning

confidence: 99%

Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry

et al. 2023

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“…8 Nonetheless, the treatment of long coronary lesions or chronic total occlusion (CTO) remains a specific challenge as it often requires the implantation of multiple stents with a variable edge-toedge overlap length. [9][10][11][12] Stent overlap is a factor clearly associated with poor clinical outcomes such as side-branch occlusion, in-stent restenosis, or stent thrombosis. [13][14][15] Therefore, the use of a single ultralong stent to address these concerns is a very attractive option.…”

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confidence: 99%

Safety and efficacy of 48 mm Xience Xpedition everolimus‐eluting stent for the treatment of long coronary lesions

Gautier

Hovasse

Arroyo

et al. 2022

Cathet Cardio Intervent

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Introduction Long drug‐eluting stents may limit the issue of overlapping multiple stents when treating long coronary lesions. Aim The aim of the study was to assess the safety and efficacy of the 48 mm Xience Xpedition everolimus‐eluting stent (48mm‐EES) for the treatment of long coronary lesions, in an all‐comer population. Methods Patients receiving at least one 48mm‐EES were prospectively included from March 2014 to December 2018. The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization (TLR) at 1 year. The main secondary endpoint was the patient‐oriented composite endpoint (POCE) defined as a composite of death, stroke, myocardial infarction, and reintervention. Results A total of 268 patients with 276 long coronary lesions, including 94 chronic total occlusions (CTO), were successfully treated using at least one 48mm‐EES. The total stent length per lesion was 66 ± 22 mm. A single 48mm‐EES was suitable to successfully treat the target lesion in 48% of cases (60% for non‐CTO lesions). One‐year follow‐up rate was 96.3%. TLF occurred in 13 patients (5.3%), mainly driven by TLR (4.1%). Two cardiac death occurred (0.7%). POCE occurred in 30 patients (11.6%) mainly driven by repeat revascularization (9.7%). Definite stent thrombosis was observed in two patients (0.7%). No difference was observed in one‐year outcomes between single 48mm‐EES and multiple stents implantation as well as between CTO and non‐CTO lesions. Conclusion The 48mm‐EES is safe and effective to treat long coronary lesions, including CTOs, and provides attractive cost‐effectiveness by limiting multiple stenting.

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“…First of all, long CTO Open access Open access lesion always needs long stent implantation, which was closely bound up with occurrence of revascularisation in unselected patients undergoing drug-eluting stent implantation. [18][19][20] For another, as our study showed, blunt stump, calcification and bending occurred more often in long CTO lesion, which signified that CTO lesions got more complex with increased occlusion length. Subintimal tracking and vessel injury seemed to be developed inevitably when management of complex CTO lesion.…”

Section: Discussionmentioning

confidence: 72%

Prognostic significance of occlusion length in recanalized chronic total occlusion lesion: a retrospective cohort study with 5-year follow-up

et al. 2020

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ObjectivesThis study sought to investigate the relationship between occlusion length and long-term outcomes of patients with recanalised chronic total occlusion (CTO) lesion.DesignA retrospective cohort study.SettingFuwai Hospital, National Center for Cardiovascular Disease, Beijing, ChinaParticipantsConsecutive patients with successfully recanalised CTO were included from January 2010 to December 2013.Primary and secondary outcome measuresThe primary endpoint of the present study was a composite event of all-cause death and myocardial infarction (MI). The secondary endpoints included target lesion revascularisation (TLR) and target vessel revascularisation (TVR).ResultsA total of 1987 patients were included and 1801 (90.6%) subjects completed 5-year follow-up in this study. Based on occlusion length, the patients were divided equally into two groups: short (length <15 mm, n=957) and long (length ≥15 mm, n=1030) CTO group. Kaplan-Meier survival curve showed no significant difference in the risk of the composite primary endpoint between short and long CTO groups (p=0.242). Receiver operating characteristic curve analysis also established occlusion length ≥15 mm as a cut-off value for predicting TLR and TVR, with an area under the curve of 0.604 (95% CI: 0.569 to 0.638, p<0.001) and 0.605 (95% CI: 0.572 to 0.638; p<0.001). Kaplan-Meier analysis revealed that the risks for TLR (p=0.002) and TVR (p=0.002) were higher in a patient with long CTO lesion. Multivariate Cox analysis also identified long CTO lesion as an independent predictor of TLR (HR: 1.539, 95% CI: 1.033 to 2.293; p=0.034) and TVR (HR: 1.476, 95% CI: 1.012 to 2.151; p=0.043).ConclusionPatients with long CTO lesion did not show a higher risk of death and MI after recanalisation, but had higher risks of TLR and TVR. Lesion with occlusion length ≥15 mm should be under close surveillance for restenosis after recanalisation.

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Clinical outcomes of long stenting in the drug-eluting stent era: patient-level pooled analysis from the GRAND-DES registry

Cited by 24 publications

References 19 publications

Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry

Sex-related impact on clinical outcomes of patients treated with drug-eluting stents according to clinical presentation: Patient-level pooled analysis from the GRAND-DES registry

Safety and efficacy of 48 mm Xience Xpedition everolimus‐eluting stent for the treatment of long coronary lesions

Prognostic significance of occlusion length in recanalized chronic total occlusion lesion: a retrospective cohort study with 5-year follow-up

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