Impact of stent diameter on outcomes following percutaneous coronary intervention with second‐generation drug‐eluting stents: Results from a large single‐center registry

Abstract

Background In patients treated with bare metal stents and first‐generation drug‐eluting stents (DES) smaller stent diameter (SD) has been associated with worse long term outcomes after percutaneous coronary intervention (PCI). Data on the impact of small SD on outcomes after PCI with second‐generation DES is scarce. Methods Consecutive patients treated with second‐generation DES between 2010 and 2016 were included in a single tertiary center. Patients were grouped according to SD: ≤2.50 mm, 2.75 ≤ 3.00 mm, 3.25 ≤ 3.50 mm, and >3.50 mm. One‐year event rates were estimated using the Kaplan–Meier method and adjusted hazard ratios were generated using Cox regression analysis. The primary endpoint was major adverse cardiac events (MACE; death, myocardial infarction [MI], or target vessel revascularization [TVR]). Results Of the 17,607 patients who underwent PCI with second‐generation DES, 32.6% (n = 5,741) had SD ≤2.5 mm, 39.1% (n = 6,890) had SD 2.75 ≤ 3.0 mm, 22.2% (n = 3,910) had SD 3.25 ≤ 3.5 mm, and 6.1% (n = 1,066) had SD >3.5 mm. At 1 year, MACE rates were 10.5%, 9.5%, 8.0%, and 8.0%, respectively, with increasing SD (p = .006). TVR rates decreased with increasing SD (7.2%, 5.8%, 4.7%, and 3.3%, respectively [p < .0001]) whereas rates of MI across SD groups were comparable (1.7%, 1.9%, 2.0%, and 1.5%, respectively [p = .60]). After multivariable adjustment, smaller SD remained associated with higher rates of MACE, TVR, and target lesion revascularization. Conclusion In a large cohort of patients undergoing PCI with second‐generation DES, smaller SD was associated with increased MACE, driven by higher rates of repeat revascularization. Further research into the optimal treatment of small coronary arteries is warranted.

Integrative Chinese and Western Medicine for patients after Percutaneous Coronary Intervention (ICWM-PCI): A Prospective Observational Real-World Cohort Study

“…Overall, the 2-year incidence of MACE in this study is 13.3% (15.0% in WMG vs. 11.2% in IMG), which is consistent with the incidence in recent relevant studies [20][21][22][23] . However, this study showed a signi cant difference in mortality between two groups, which has an obvious discrepancy with previous studies about ICWM for patients after PCI 8-10, 13 .…”

Joint effect of platelet distribution width and stent surface area on major adverse cardiovascular events after percutaneous coronary intervention

“…Therefore, caution should be taken when interpreting the results. Second, although SSA is strongly correlated with reference vessel diameter and SD (11,27). However, no information on reference vessel diameter has been reported thus far.…”

“…Although the data on the association between SSA and MACEs after PCI is very limited, the length and diameter of stent have been reported as independent predictors of MACEs after PCI with DES implantation (11,(14)(15)(16)(17). For instance, the results from a meta-analysis found that females with smaller SDstreated with PCI had ahigher risk of definite stent thrombosis and target lesion revascularization, consistent with earlyand newgenerations of DES (18).…”

“…In addition, several stent characteristics, such as stent length and diameter, have also been reported as important parameters for the subsequent risk of MACEs after PCI procedures (10]. For instance, Plitt et al reported that a stent diameter (SD) value of 3.25-3.5 mm and and anSD value >3.5 mm were significantly associated with a 21% and 34% lower risk for MACE rates, respectively, in comparision with an SD level of ≤2.5 mm (11). Stent surface area (SSA) is a comprehensive index value that can reflect the length and diameter of stent.…”

Applied pharmacology in percutaneous coronary intervention: You can't fight mother nature

“…4 In this issue, Pitt et al report outcomes of small vessel intervention compared to large vessel revascularization using second generation stent sizing as a surrogate for randomization in a large single center retrospective study. 5 17,607 patients at an expert and busy tertiary care center were stratified into four groups by stent diameters (SD), but not core-lab adjudicated vessel size, based on the smallest target vessel intervened on. Clinical outcomes were then reported 1-year as composite primary end point of death, MI, or TVR which were adjusted for differences in demography, procedural, and co-morbidity characteristics.…”