The Preventive Effect on In-Stent Restenosis of Overlapped Drug-Eluting Stents for Treating Diffuse Coronary Artery Disease

Kim, Weon; Jeong, Myung Ho; Cho, Jae Yeoung; Cho, Jung Sun; Hwang, Seung Hwan; Lee, Sang Rok; Lim, Sang Yup; Hong, Young Joon; Hong, Seo Na; Kim, Kye Hun; Son, Il Suk; Park, Hyung Wook; Kim, Ju Han; Ahn, Young Keun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

BACKGROUND AND OBJECTIVES
Diffuse coronary artery disease presents physicians with a therapeutic challenge. The results after the use of bare metal stents (BMS) are limited by the high rate of restenosis. The introduction of drugeluting stent (DES) has prompted interventional cardiologists to treat long diffuse lesions with multiple overlapping stents. The purpose of this study is to determine the safety and efficacy of using multiple overlapping DESs for patients with diffuse coronary artery disease.
SUBJECTS AND METHODS
From Jan. 2002 to Dec 2004, 83 consecutive patients suffering with diffuse coronary artery disease who underwent stent implantation with a minimum of 50 mm long BMSs or DESs were analyzed. The patients who had overlapping stents for dissection without diffuse lesion or they had BMS with overlapping DES were excluded from the study. The patients were divided into two group, the BMS group (group I: 29 patients, 63.0+/-8.2 years) and the DES group (group II: 56 patients, 60.6+/-9.3 years). The major adverse cardiac events (MACE), including death, myocardial infarction (MI), target vessel revascularization (TVR) and coronary artery bypass grafting (CABG), were examined.
RESULTS
The mean number of stents implanted was 2.19+/-0.4 in group I and 2.08+/-0.2 in group II, whereas the total mean length of the stents was 61.5+/-9.3 mm in group I and 61.4+/-9.1 mm in group II (p=NS). Procedural success was achieved for 89.7% of the patients in group I and for 96.3% of the patients in group II. No acute stent thrombosis was observed in both groups. All the patients underwent clinical follow-up (mean follow-up: 15+/-8.9 months, range: 7-36 months), and 66.2 % had an angiographic follow-up done at six months. During the follow-up, MACE was the cause of two deaths; there were thirteen TVRs and one CABG in group I, and there was one MI and five TVRs in group II. The TVR rate was lower in group II compared with group I (44.8% vs. 9.3%, respectively; p<0.001). Late stent thrombosis developed for one patient in group II.
CONCLUSION
The implantation of overlapping DESs in patients with diffuse coronary artery disease is safe and this treatment is associated with better clinical outcomes than that with using BMS.