Journal List > Korean Circ J > v.38(11) > 1016401

Lee, Chun, Cho, Lee, Oh, Ahn, Kim, Lee, Kim, Bae, Ko, Jeong, Kim, Lee, Kim, Kim, Hong, and Shin: Impact of Drug-Eluting Stents on Clinical Outcomes in Patients With Diffuse Coronary Lesions

Abstract

Background and Objectives

In the era of stents, lesion length remains an important predictor of restenosis. Drug-eluting stents (DESs) have significantly reduced in-stent restenosis (ISR), but results in long lesions are still lacking. Therefore, we investigated the impact of DESs on clinical outcomes in patients with diffuse coronary lesions.

Subjects and Methods

Between January 2004 and January 2005, 80 patients (94 lesions) with lesions >20 mm in length were treated with one or more DESs and underwent follow-up coronary angiography. The patients were divided into three groups: Group 1 was composed of those with lesions 21 to 35 mm in length, Group 2 was composed of those with lesions 36 to 50 mm in length, and Group 3 was composed of those with lesions ≥51 mm in length.

Results

The mean clinical follow-up duration was 9 months. On the 6-month follow-up angiogram, 6.4% of the lesions had binary ISR (5.0% in group 1, 8.7% in group 2, and 9.1% in group 3). The percent diameter stenosis was 6.0±18.15% in Group 1, 12.61±21.99% in Group 2, and 19.81±31.26% in Group 3(p< 0.05). Late lumen loss was 0.17±0.50 mm in Group 1, 0.39±0.66 mm in Group 2, and 0.59±0.93 mm in Group 3 (p<0.05). Lesion length was associated with an increase in percent diameter stenosis and late lumen loss (of 6.9% and 0.21 mm per 15 mm).

Conclusion

DES implantation is considered safe and effective in the treatment of diffuse lesions. However, lesion length may be associated with an increase in percent diameter stenosis and late lumen loss at 6-month follow-up.

Figures and Tables

Fig. 1
Percent diameter stenosis among the 3 groups. Group 1 was composed of those patients who had lesions 21 to 35 mm in length, Group 2 was composed of those who had lesions 36 to 50 mm in length, and Group 3 was composed of those who had lesions ≥51 mm in length. *p<0.05. DS: diameter stenosis.
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Fig. 2
Late lumen loss based on quantitative coronary angiography among the 3 groups. Group 1 was composed of those patients who had lesions 21 to 35 mm in length, Group 2 was composed of those who had lesions 36 to 50 mm in length, and Group 3 was composed of those who had lesions ≥51 mm in length. *p<0.05.
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Table 1
Baseline characteristics and nine-month outcomes
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Group 1 for those who had 21 to 35 mm in lesion length, Group 2 for those who had 36 to 50 mm in lesion length, Group 3 for those who had ≥51 mm in lesion length, Dyslipidemia: LDL-cholesterol ≥130 mg/dL. SA/UA/AMI: stable angina/unstable angina/acute myocardial infarction, MACE: major adverse cardiac events at nine months, MI: myocardial infarction, TVR: target vessel revascularization, LDL: low density lipoprotein

Table 2
Angiographic characteristics at baseline and after procedure
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Group 1 was composed of those patients who had lesions 21 to 35 mm in length, Group 2 was composed of those who had lesions 36 to 50 mm in length, and Group 3 was composed of those who had lesions ≥51 mm in length. LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery, SES: sirolimus eluting stent, PES: paclitaxel eluting stent, PCI: percutaneous coronary intervention, RD: reference diameter, MLD: minimal lumen diameter, ISR: in stent restenosis

Table 3
Nine-month follow-up angiographic characteristics
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Group 1 was composed of those patients who had lesions 21 to 35 mm in length, Group 2 was composed of those who had lesions 36 to 50 mm in length, and Group 3 was composed of those who had lesions ≥51 mm in length. ISR: in-stent restenosis

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