Importance of lesion length on new device angioplasty of native coronary arteries

The influence of lesion length on early and late outcomes after new device angioplasty has not been well documented. We reviewed the clinical and angi ographic outcomes of 2,980 patients (3,902 lesions) undergoing new device a ngioplasty of native vessels enrolled in the New Approaches to Coronary Int erventions (NACI) Registry. Patients were divided into three groups accordi ng to the longest lesion length (< 10, 10-20, and > 20 mm) treated. Patient s with the longest lesions had more multivessel disease (56.9% vs. 49.0%, P < 0.05), right coronary artery disease (52.7% vs. 32.0%, P < 0.001), and t otal occlusions (19.1% vs. 2.5%, P < 0.001) than patients with shorter lesi ons. Longest lesions had the smallest minimal lumen diameter (P < 0.001) at baseline and at the end of the procedure. Although in-hospital events were similar, there were differences in clinical outcomes at 1 year due mainly to more target lesion revascularization in the longest lesion group (P < 0. 01). Multivariate analysis showed that each 1-mm increase in lesion length was associated with an increase relative risk of 1.014 (95% CI, 1.004-1.025 ) for target lesion revascularization at 1 year. We conclude that despite s imilar early clinical events, patients undergoing new device angioplasty of longer lesions have more target lesion revascularization at 1 year. (C) 20 00 Wiley-Liss, Inc.