Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
Department of Cardiac and Vascular Diseases, Institute of Cardiology, John Paul II Hospital, Kraków, Poland
Pol Arch Intern Med. 2019 Jun 28;129(6):392-398. doi: 10.20452/pamw.14864. Epub 2019 Jun 6.
Long and diffuse coronary lesions (LDCLs) are routinely subjected to percutaneous management, but long‑term clinical outcomes and complication predictors with the use of contemporary stents and techniques remain undetermined.
The aim of the study was to address long‑term effects of percutaneous management of LDCLs, using contemporary devices and optimization techniques.
Long and diffuse coronary lesion was defined as a lesion requiring an implantation of 30 mm or longer total stent(s) length (TSL) into one coronary artery (bailouts excluded). There were 290 LDCL interventions with the use of newer generation drug‑eluting stents (DESs; cobalt chromium everolimus- or zotarolimus-eluting stents) performed between January 2013 and January 2016.
The mean (SD) TSL was 55.5 (16.8) mm. The use of intravascular ultrasound / optical coherence tomography was 17.1%, rotablation, 6.9%, and noncompliant balloon, 88.9%. The median (range) follow‑up duration was 831 (390-1373) days. All‑cause mortality and cardiac death rates were 11.7% and 6.9%, respectively. The myocardial infarction (MI) rate was 6.6%, including target‑vessel MI in 4.1%. The rate of clinically‑driven repeat revascularization was 13.8%, and of definite or probable LDCL stent thrombosis, 7.2%. Overall patient‑oriented adverse event rate (any death, MI, or repeat revascularization) was 25.5%, and device‑oriented rate (cardiac death, target vessel‑MI, or target lesion restenosis), 13.4%. Adverse outcome predictors were chronic kidney disease, acute coronary syndrome as an indication for the procedure, chronic heart failure with reduced left ventricular ejection fraction, multivessel disease, and coexisting peripheral artery disease, but not lesion‑related factors, such as bifurcation, calcification, chronic total occlusion, or TSL.
Adverse outcomes following contemporary LDCL management using newer generation DESs in routine clinical practice are associated with clinical patient characteristics rather than lesion characteristics or TSL. We identified high‑risk patient cohorts that may benefit from enhanced surveillance.
长而弥散的冠状动脉病变（LDCL）通常需要经皮治疗，但使用现代支架和技术的长期临床结果和并发症预测因素仍不确定。
本研究旨在探讨使用现代器械和优化技术治疗 LDCL 的长期效果。
长而弥散的冠状动脉病变定义为需要在一条冠状动脉中植入 30mm 或更长总支架长度（TSL）的病变（排除补救措施）。2013 年 1 月至 2016 年 1 月期间，共对 290 例 LDCL 病变进行了干预，使用了新一代药物洗脱支架（DES；钴铬依维莫司或佐他莫司洗脱支架）。
平均（标准差）TSL 为 55.5（16.8）mm。血管内超声/光学相干断层扫描的使用率为 17.1%，旋磨术使用率为 6.9%，非顺应性球囊使用率为 88.9%。中位（范围）随访时间为 831（390-1373）天。全因死亡率和心源性死亡率分别为 11.7%和 6.9%。心肌梗死（MI）发生率为 6.6%，其中靶血管 MI 发生率为 4.1%。临床驱动的再次血运重建率为 13.8%，明确或可能的 LDCL 支架血栓形成率为 7.2%。总体患者导向的不良事件发生率（任何死亡、MI 或再次血运重建）为 25.5%，器械导向的不良事件发生率（心源性死亡、靶血管-MI 或靶病变再狭窄）为 13.4%。不良预后的预测因素包括慢性肾脏病、该手术的急性冠状动脉综合征指征、射血分数降低的慢性心力衰竭、多血管病变和并存的外周动脉疾病，但与病变相关的因素，如分叉、钙化、慢性完全闭塞或 TSL 无关。
在常规临床实践中使用新一代 DES 治疗 LDCL 后，不良预后与临床患者特征有关，而与病变特征或 TSL 无关。我们确定了高危患者群体，他们可能受益于增强监测。
