Yonsei Med J.  2014 May;55(3):584-591. 10.3349/ymj.2014.55.3.584.

Comparison of Full Lesion Coverage versus Spot Drug-Eluting Stent Implantation for Coronary Artery Stenoses

• Kim S
• Yun KH
• Kang WC
• Shin DH
• Kim JS
• Kim BK
• Ko YG
• Choi D
• Jang Y
• Hong MK

• KMID: 2068666
• DOI: http://doi.org/10.3349/ymj.2014.55.3.584

Abstract

PURPOSE
The aim of this study was to evaluate and compare the long-term clinical outcomes of the spot drug-eluting stent (DES) implantation strategy, which is used to minimize implanted stent length and the number of stents, versus full lesion coverage for treatment of coronary artery stenoses.
MATERIALS AND METHODS
We evaluated 1-year clinical outcomes of 1619 patients with stent implantation for a single coronary lesion. They were divided into two groups: those treated by full lesion coverage (n=1200) and those treated with the spot stenting strategy (n=419). The combined occurrence of 1-year target vessel failure (TVF), including cardiac death, target-vessel related myocardial infarction, or ischemia-driven target-vessel revascularization was evaluated.
RESULTS
The spot DES implantation group had a shorter stent length (23.14+/-9.70 mm vs. 25.44+/-13.24 mm, respectively; p<0.001) and a fewer number of stents (1.09+/-0.30 vs. 1.16+/-0.41, respectively; p<0.001), even though the average lesion length was similar to the full lesion coverage group (21.36+/-10.30 mm vs. 20.58+/-10.97 mm, respectively; p=0.206). Spot DES implantation was superior to full DES coverage with respect to 1-year TVF (1.4% vs. 3.3%, p=0.044). Cox proportional hazard model analysis showed that the risk for 1-year TVF was almost 60% lower among patients who received spot DESs compared to those who received full DES coverage after adjustment for other risk factors (HR=0.40, 95% confidence interval=0.17-0.98; p=0.046).
CONCLUSION
Minimizing stent length and the number of stents with overlapping by spot DES implantation may result in reduced rates of 1-year TVF, compared with full DES coverage.

Keyword

Drug-eluting stents; percutaneous coronary intervention; coronary artery disease

MeSH Terms

Aged
Coronary Stenosis/*surgery
*Drug-Eluting Stents
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention/*methods

Figure

• 

  Fig. 1 Cumulative incidence of target vessel failure at 1 year. One year time-to-event curves are shown for target vessel failure in patients treated with full DES coverage versus spot DES implantation. Event rates represent Kaplan-Meier estimates. The p values are based on the log-rank test. CI, confidence interval; DES, drug-eluting stent.

• 

  Fig. 2 Subgroup analyses of the 1-year rates of target vessel failure. Subgroup analyses are shown for the target vessel failure at 1 year among subgroups of patients treated with full DES coverage versus spot DES implantation. The p value for interaction represents the likelihood of interaction between the variable and the relative treatment effect. CI, confidence interval; DES, drug-eluting stent; E-ZES, Endeavor zotarolimus-eluting stent; MI, myocardial infarction; MLD, minimal lumen diameter.

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