Khanal Suraj, Agarwal Ayush, Kumar Basant
Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND.
Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND.
Cureus. 2024 May 3;16(5):e59611. doi: 10.7759/cureus.59611. eCollection 2024 May.
Background and objective Diffuse coronary artery disease (CAD) is associated with extensive involvement of coronary arteries, necessitating the use of long (≥40 mm) drug-eluting stents (DES) based on the lesion length. However, these long DES can lead to complications such as in-stent restenosis (ISR) and stent thrombosis. This study aimed to assess the safety, efficacy, and one-year clinical outcomes of using long DES in patients with diffuse CAD undergoing PCI at a tertiary care hospital in north India. Methodology Patients with diffuse CAD undergoing PCI with long DES between January 2017 and June 2022 were included in the study. Baseline characteristics were recorded, and patients were followed up telephonically or in the outpatient department (OPD) at one, three, six, and 12 months following the PCI. The primary endpoint was the target lesion failure (TLF) rate, with secondary endpoints constituting all-cause mortality, major adverse cardiovascular events (MACE), subacute stent thrombosis, and ISR. Results A total of 200 patients were recruited and followed up for one year. The median age of the patients was 58 years (range: 48.25-63 years), and 82% were men. The most frequently stented artery was the left anterior descending (LAD, 48%), followed by the right coronary artery (RCA, 36%). A total of 388 stents (mean: 1.94 ±0.79) were implanted, including both long and short stents. The mean length and diameter of long stents were 43.64 ±3.58 mm and 3 ±0.37 mm, respectively. At the one-year follow-up, patients undergoing PCI with long DES ≥40 mm had an overall TLF rate of 5%, all-cause mortality of 6% (12 patients), MACE of 6% (12 patients), subacute stent thrombosis of 4% (eight patients), and ISR of 1% (two patients). A large proportion of patients (90%) had an uneventful follow-up of up to a year. At the one-year follow-up, all 10 (5%) patients with a primary outcome had a smaller stent diameter than those without a primary outcome (2.5 ±0.25 mm vs. 3.03 ±0.35 mm, p=0.015). Conclusions Our results suggest that using extremely long stents (>40 mm) for diffuse coronary lesions is safe, efficacious, and associated with relatively low event rates. In addition, the stent diameter has a substantial correlation with the primary outcome. Further studies with larger sample sizes as well as longer follow-up periods are required to validate our findings.
背景与目的 弥漫性冠状动脉疾病（CAD）与冠状动脉的广泛受累相关，基于病变长度需要使用长（≥40 mm）药物洗脱支架（DES）。然而，这些长DES可能导致诸如支架内再狭窄（ISR）和支架血栓形成等并发症。本研究旨在评估在印度北部一家三级医疗中心对弥漫性CAD患者进行PCI时使用长DES的安全性、有效性及一年临床结局。
方法 纳入2017年1月至2022年6月期间接受长DES PCI治疗的弥漫性CAD患者。记录基线特征，并在PCI术后1、3、6和12个月通过电话或门诊（OPD）对患者进行随访。主要终点为靶病变失败（TLF）率，次要终点包括全因死亡率、主要不良心血管事件（MACE）、亚急性支架血栓形成和ISR。
结果 共招募200例患者并随访一年。患者的中位年龄为58岁（范围：48.25 - 63岁），82%为男性。最常置入支架的血管是左前降支（LAD，48%），其次是右冠状动脉（RCA，36%）。共植入388枚支架（平均：1.94±0.79），包括长支架和短支架。长支架的平均长度和直径分别为43.64±3.58 mm和3±0.37 mm。在一年随访时，接受≥40 mm长DES PCI的患者总体TLF率为5%，全因死亡率为6%（12例患者），MACE为6%（12例患者），亚急性支架血栓形成为4%（8例患者），ISR为1%（2例患者）。很大一部分患者（90%）随访至一年情况良好。在一年随访时，所有10例（5%）出现主要结局的患者的支架直径均小于未出现主要结局的患者（2.5±0.25 mm对3.03±0.35 mm，p = 0.015）。
结论 我们的结果表明，对弥漫性冠状动脉病变使用极长支架（>40 mm）是安全、有效的，且事件发生率相对较低。此外，支架直径与主要结局有显著相关性。需要进行更大样本量以及更长随访期的进一步研究来验证我们的发现。
