Impact of multiple and long sirolimus-eluting stent implantation on 3-year clinical outcomes in the j-Cypher Registry
Shinichi Shirai, Takeshi Kimura, Masakiyo Nobuyoshi, Takeshi Morimoto, Kenji Ando, Yoshimitsu Soga, Kyohei Yamaji, Katsuhiro Kondo, Koyu Sakai, Takeshi Arita, Masahiko Goya, Masashi Iwabuchi, Hiroyoshi Yokoi, Hideyuki Nosaka, Kazuaki Mitsudo, j-Cypher Registry Investigators, Shinichi Shirai, Takeshi Kimura, Masakiyo Nobuyoshi, Takeshi Morimoto, Kenji Ando, Yoshimitsu Soga, Kyohei Yamaji, Katsuhiro Kondo, Koyu Sakai, Takeshi Arita, Masahiko Goya, Masashi Iwabuchi, Hiroyoshi Yokoi, Hideyuki Nosaka, Kazuaki Mitsudo, j-Cypher Registry Investigators
Abstract
Objectives: Our aim was to study the relationships between total stent length (TSL) and long-term clinical outcomes after sirolimus-eluting stent (SES) implantation.
Background: SES compared with bare-metal stent use for long lesion treatment is associated with reduced restenosis rates.
Methods: Three-year follow-up data were available for 10,773 patients (14,651 lesions) that had been treated with only SES (Cypher, Cordis Corp., Warren, New Jersey) in the j-Cypher registry. Patients and lesions were divided into quartile groups: TSL per patient (Q1: 8 to 23 mm, Q2: 24 to 36 mm, Q3: 37 to 54 mm, Q4: 55 to 293 mm), and TSL per lesion (QA: 8 to 18 mm, QB: 19 to 23 mm, QC: 24 to 33 mm, QD: 34 to 150 mm).
Results: In per-lesion data, longer TSL increased target lesion revascularization (TLR) rates but did not increase stent thrombosis rates (p = 0.2324). In per-patient data, the incidences of TLR remarkably increased with increasing TSL. Incidence of composite of death and myocardial infarction also increased with increasing TSL; however, after adjustment for baseline differences, there was no statistical significance. Definite stent thrombosis rate in group Q4 was significantly higher than in other groups, both unadjusted (hazard ratio: 1.770, p = 0.0081) and adjusted (hazard ratio: 1.727, p = 0.0122) for baseline differences.
Conclusions: TSL per lesion and patient had significantly impacts on TLR rates. Longer TSL per patient was associated with increased incidence of stent thrombosis through 3 years.
Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed