Feasibility and Clinical Outcomes of 48 mm Drug-Eluting Stents in the Management of Patients With Coronary Artery Disease

Background. Long coronary lesions represent a formidable challenge during percutaneous coronary intervention (PCI). Implantation of multiple contiguous stents may result in sections of overlapping stents or gaps of unstented segments and is an independent predictor of restenosis and major adverse cardiovascular events (MACEs). Objectives. The study goal was to assess the feasibility and short-term clinical outcomes of implanting 48 mm drug-eluting stents (DESs) for the treatment of long lesions in patients with coronary artery disease (CAD). Methods. This prospective study enrolled 300 patients, with a single CAD planned to undergo PCI with 48 mm DES. Clinical data, procedural outcomes, and follow-up to 6 months were obtained. MACEs were considered the combined study endpoint, defined as cardiac death, non-fatal myocardial infarction, unstable angina, and the need for target-lesion revascularization (TLR). Results. Among the 300 subjects enrolled, 80% were men and mean age was 60.8 +/- 8.6 years. Procedural success rate was 97.3%. Failure of crossing was encountered in 4 patients due to severe tortuosity. Six-month clinical outcome was compared between diabetic (DM) (n=90) and non-DM patients; 6-month cumulative MACEs were significantly lower in the non-DM group than in DM group (2.9% vs 13.3%, respectively; P=.01). Clinically driven TLR was 4% and 2 cardiac deaths were reported. The independent predictors of repeat revascularization were insulin-treated type 2 DM and reference vessel diameter (RVD) <= 2.75 mm. Conclusion. The use of 48 mm DES is feasible, safe, and cost effective in the treatment of long coronary lesions. Independent predictors of repeat revascularization are type 2 DM and RVD=2.75 mm.