Long-term outcome of patients with very long stents for treatment of diffuse coronary disease

Objectives The study sought to determine the 6-month clinical outcome of pa tients who underwent implantation of very long coronary stents to treat dif fuse disease and/or long dissections and to compare the findings with those reported in the literature for patients who underwent implantation of mult iple short coronary stents. Background New designs of flexible stents enable the implantation of long s tents rather:han multiple short, older design stents. The initial experienc e is very promising but the long-term outcome has not been described yet. Methods Fifty-seven consecutive patients in whom 67 long stents (greater th an or equal to 30 mm) were successfully deployed were included in this stud y. Six-month clinical and angiographic follow-up was prospectively collecte d, patients with recurrent angina underwent coronary angiography without fu rther testing. patients who remained asymptomatic at the 6-month follow-up visit underwent positron emission tomographic imaging, and those with resul ts suggestive of ischemia underwent coronary angiography. A combined study end point was defined as death, myocardial infarction, and the need for tar get vessel revascularization. Results Only 1 patient (2%) reached a study end point at hospital discharge . An additional 20 patients (total 21 patients [37%]) reached an end point by 6 months. The outcome was not influenced by the clinical presentation (s table or unstable angina) or by the indication for stenting (elective or em ergency). Predictors For adverse outcome were multiple stents per narrowing (63% vs 29%, P <.04), and stents smaller than 3.5 mm (49% vs 22%). Narrowi ng and stent length were not predictive of a study end point in narrowings that were successfully treated by a single long stent. Conclusions Elective stenting provides an effective solution for patients w ith diffuse coronary disease provided that ct single long stent (usually <4 0 mm) can cover the full length of the narrowing. The results are better wh en vessels larger than 3 mm are treated. Compared with multiple short stent s, implantation of a single long stent is probably at least as effective, a nd the procedure is quicker and cheaper and thus should be the preferred ap proach.