The relationship and threshold of stent length with regard to risk of stent thrombosis after drug-eluting stent implantation

Abstract

Objectives: The aim of this study was to evaluate the association between the length of the stented segment and the risk of stent thrombosis (ST) after drug-eluting stent (DES) implantation and to determine the cutoff value of stent length in higher risk of ST in routine clinical practice.

Background: Despite the recommendations of full lesion coverage to prevent angiographic restenosis, the length of the stented segment has been a risk factor for DES-related ST.

Methods: A total of 3,145 consecutive patients (4,667 lesions) who underwent DES implantation were analyzed. The independent association of stent length with ST and its predictive value were evaluated for a median 29.6 months (interquartile range 21.6 to 37.5 months).

Results: Stent thrombosis occurred in 68 patients (2.2%) at 3 years. The stent length/lesion was an independent predictor of ST (hazard ratio: 1.11, 95% confidence interval: 1.06 to 1.15, p < 0.001). The threshold of stent length for predicting ST was 31.5 mm (area under the receiver-operating characteristic curve: 0.746, 95% confidence interval: 0.699 to 0.793, p < 0.001), which had a sensitivity and specificity of 88.4% and 52.1%, respectively. Stent lengths >or=31.5 mm were associated with higher rates of ST (4.0% vs. 0.7%, p < 0.001), death (5.2% vs. 3.0%, p = 0.005), and myocardial infarction (2.4% vs. 0.7%, p = 0.001) at 3 years, as compared with stent lengths <31.5 mm.

Conclusions: Length of the stented segment was independently associated with the incidence of ST and death or myocardial infarction after DES implantation. The value of stent length >or=31.5 mm is a threshold for the prediction of ST.

Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.