The influence of stent length on clinical and angiographic outcome in patients undergoing elective stenting for native coronary artery lesions - Final results of the Magic 5L Study

Aims To prospectively evaluate the influence of stent length on 6 month cli nical and angiographic outcome, in patients with native coronary lesions up to 45 mm in length, undergoing elective Magic Wallstent implantation, Methods and Results On the basis of pre-procedural angiography, 276 patient s (aged 61.3 +/- 10.2 years; 78.6% male; 41.7% unstable angina) with a tota l of 302 lesions were prospectively assigned to one of five different lengt h categories of Magic Wallstent. Angiography in multiple matched projection s before and after implantation and at 6 months follow-up was analysed at t he core laboratory. Primary end-points for the efficacy analysis were cumul ative incidence of major adverse cardiac events and quantitative coronary a ngiography analysis 6 months after stent implantation. Magic Wallstent impl antation was successful in 301 of 302 lesions and in 98.6%. a residual sten osis <20% by online quantitative coronary angiography was achieved. At 30 d ays, 6.2%. (1.8% subacute occlusion) of patients had experienced major adve rse cardiac events, 27.5%, at 6 months and 30.4% at 9 months. Angiographic restenosis occurred in 37%, Restenosis rates for the mini, extra-short, sho rt, medium and long Wallstent groups were 25.9%, 25%, 22.6%, 36.2% and 67.5 %, respectively. Multivariate analysis revealed stent length to be independ ently associated with greater angiographic restenosis and major adverse car diac events. Conclusions While shorter Magic Wallstents provided late outcomes comparabl e with short balloon-expandable stents, excessive restenosis with longer Wa llstents should obviate their use in elective percutaneous intervention. Lo ng coronary lesions provide a challenging substrate for emerging antiresten osis therapies, such as stent coatings and brachytherapy. (Eur Heart J 2001 ; 22: 1585-1593, doi:10.1053/euhj.2001. 2752) (C) 2001 The European Society of Cardiology.