Sun Hwa Lee; Jei-Keon Chae; Kang-Hyu Lee; Sang-Rok Lee; Kyoung-Suk Rhee; Won-Ho Kim; Jae-Ki Ko

doi:10.4070/kcj.2008.38.2.87

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Lee, Chae, Lee, Lee, Rhee, Kim, and Ko: Full Metal Jackets (≥60 mm) of Drug-Eluting Stents: Short- and Long-term Clinical and Angiographic Outcomes

Original Article

Korean Circulation Journal

Korean Circulation Journal 2008; 38(2): 87-94.

Published online: 29 February 2008

DOI: https://doi.org/10.4070/kcj.2008.38.2.87

Full Metal Jackets (≥60 mm) of Drug-Eluting Stents: Short- and Long-term Clinical and Angiographic Outcomes

Sun Hwa Lee, MD, Jei-Keon Chae, MD, Kang-Hyu Lee, MD, Sang-Rok Lee, MD, Kyoung-Suk Rhee, MD, Won-Ho Kim, MD, Jae-Ki Ko, MD

Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

Correspondence: Jei-Keon Chae, MD, Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, San 2-20 Geumam-dong, Deokjin-gu, Jeonju 561-180, Korea. Tel: 82-63-250-1839, Fax: 82-63-250-1680, jkchae@chonbuk.ac.kr

Received 20 September 2007 Revised 6 November 2007 Accepted 19 November 2007

Abstract

Background and Objectives

Drug-eluting stents (DES) are effective for the maintenance of patency in patients with various complex coronary artery diseases. We investigated the efficacy of full metal jackets (FMJs,≥60 mm) using overlapping DES for very long coronary lesions.

Subjects and Methods

The medical records and angiographic data of ninety-nine patients, and 100 FMJs that were implanted at Chonbuk National University Hospital since March 2003, were analyzed.

Results

The mean age was 63±10 years and median follow-up period was 17.0 months. The mean lesion length was 57.7±10.8 mm, the mean number of implanted DES for FMJ was 2.2±0.5, and the mean length of the FMJ was 68.5±11.4 mm. Thirty percent of the lesions were the culprits of acute myocardial infarction and 22% were chronic total occlusive lesions. The procedural success rate was 98%. Triple antiplatelet agents were prescribed for 37.4% of the patients and the mean duration of clopidogrel use was 11.9±5.7 months. Overall major adverse cardiac events developed in 10% of patients. One patient died of probable stent thrombosis by the Academic Research Consortium definition. Follow-up coronary angiography was performed in 69% of cases. Binary restenosis was documented in 9 lesions (13.0%) and five FMJs (7.2%) were revascularized. Stent fractures were detected in four FMJs (5.8%).

Conclusion

Although FMJs using DES may be regarded as a relatively safe and effective therapeutic approach for diffuse long coronary lesions, longer-term follow-up data with a larger population is needed to establish safety including special consideration for strategy of antiplatelet therapy.

Keywords: Drug-Eluting stents, Percutaneous transluminal coronary angioplasty

Figures and Tables

Fig. 1

Kaplan-Meier cardiac event-free survival curve.

Table 1

Patient demographics

MI: myocardial infarction, PCI: percutaneous coronary intervention, CABG: coronary artery bypass graft, CHD: coronary heart disease, PAOD: peripheral arterial occlusive disease, CKD: chronic kidney disease, ESRD: end-stage renal disease, STEMI: ST-segment elevation myocardial infarction, NSTEMI: non-ST-segment elevation myocardial infarction, LVEF: left ventricular ejection fraction

Table 2

Lesion characteristics

^*ACC/AHA lesion classification system. FMJ: full metal jacket, PCI: percutaneous coronary intervention, CTO: chronic total occlusion, LMCA: left main coronary artery, LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery, ACC/AHA: American College of Cardiology/American Heart Association, TIMI: thrombolysis in myocardial infarction

Table 3

Procedural characteristics

^*Dual antiplatelet therapy: aspirin+clopidogrel, triple antiplatelet therapy: aspirin+clopidogrel+cilostazol. PCI: percutaneous coronary intervention, FMJ: full metal jacket, DES: drug-eluting stent, SES: sirolimus-eluting stent, PES: paclitaxel-eluting stent, ZES: zotarolimus-eluting stent, TIMI: thrombolysis in myocardial infarction, CK-MB: MB fraction of creatine kinase, UNL: upper normal limit, MACE: major adverse cardiac events

Table 4

Angiographic follow-up data

^*Classification of in-stent restenosis,16) ^†By ARC (Academic Research Consortium) definition.17) CAG: coronary angiography, DES: drug-eluting stent, SES: sirolimus-eluting stent, ZES: zotarolimuseluting stent, TLR: target lesion revascularization, FMJ: full metal jacket, CABG: coronary artery bypass graft

Table 5

Quantitative coronary angiographic data

Table 6

Clinical follow-up data

MACE: major adverse cardiac events (defined as cardiac death, myocardial infarction or target lesion revascularization), TLR: target lesion revascularization

Table 7

Predictors of restenosis or adverse cardiac events

^*p<0.05. ISR: in-stent restenosis, MACE: major adverse cardiac events, LVEF: left ventricular ejection fraction, ACS: acute coronary syndrome, CKD: chronic kidney disease, CTO: chronic total occlusion, IRA: infarct-related artery, TIMI: thrombolysis in myocardial infarction, RD: reference diameter, MLD: minimal lumen diameter, FMJ: full metal jacket

Table 8

Data comparing features of previous and current studies using multiple overlapping drug-eluting stents for diffuse long coronary lesions (ordered by mean overlapping stent length)

^*Patient number (lesion number), ^†Mixed use of two different kinds of drug-eluting stents. RD: reference diameter, SES: sirolimus-eluting stent, PES: paclitaxel-eluting stent, AMI: acute myocardial infarction, CTO: chronic total occlusion, FU: follow-up, CAG: coronary angiography, ISR: instent restenosis, TLR: target lesion revascularization, ST: stent thrombosis, MACE: major adverse cardiac events, NA: not available

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