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Publications

Journal Article Multicenter Study Comparative Study Ppublish

PubMed: 39950761 DOI: 10.1097/HPC.0000000000000371

Impact of Single Long Stents Versus Overlapping Stents on Clinical Outcomes in Primary PCI.

Crit Pathw Cardiol 24(1):e0371

Authors: Guilherme Pinheiro Machado, Martin Negreira-Caamaño, Daniel Tébar Márquez, Marcia Moura Schmidt, Alan Pagnoncelli, Gustavo Neves de Araujo, Sandro Cadaval Goncalves, Marco Wainstein, Alexandre Schaan de Quadros, Alfonso Jurado-Román, Rodrigo Wainstein

Affiliations

  • From the Cardiology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
  • Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain.
  • Cardiology Department, La Paz University Hospital, Madrid, Spain.
  • Interventional Cardiology Department, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.
  • Cardiology Department, Hospital da Unimed Grande Florianopolis, São José, Brazil.

Abstract

BACKGROUND

Patients with long coronary lesions undergoing primary percutaneous coronary intervention (pPCI) have higher rates of adverse clinical events. Both stent length and stent overlap are associated with worse outcomes; however, data comparing very long stent (VLS) to overlapping stents (OSs) are limited, particularly during pPCI. This study aimed to compare the impact of a single VLS versus ≥2 OSs on clinical outcomes in a multicenter registry of patients undergoing pPCI.

METHODS

This study included patients with ST-segment elevation myocardial infarction (STEMI) who underwent pPCI using a single VLS (≥38 mm) or ≥2 OS (total stent length, ≥38 mm) in the culprit lesion. After propensity score matching based on tortuosity, calcification, Killip class, culprit lesion length ≥40 mm, and culprit vessel, the final cohort for analysis was selected. The primary endpoint was a combination of mortality and target lesion failure (reinfarction, stent thrombosis, or new revascularization) at 2 years.

RESULTS

Among 647 consecutive STEMI patients who underwent pPCI between March 2016 and September 2022, 353 received VLS and 294 received OSs. After propensity score matching, 264 patients remained (132 in each group). The occurrence of the primary outcome (VLS: 12.9 vs. OS: 15.9%; P = 0.86), all-cause mortality (VLS: 7.6 vs. OS: 9.8%; P = 0.51), and target lesion failure (VLS: 8.3 vs. OS: 6.8, P = 0.64) were similar between the 2 groups.

CONCLUSIONS

In this cohort of real-world patients with STEMI undergoing pPCI, we found no significant difference in outcomes between VLS and OSs. Both strategies are reasonable treatment options for STEMI patients.

MeSH

Stents, Mortality, Cardiovascular Diseases, Propensity Score, St Elevation Myocardial Infarction