Effect of Increasing Stent Length on 3-Year Clinical Outcomes in Women Undergoing Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents: Patient-Level Pooled Analysis of Randomized Trials From the WIN-DES Initiative

Jaya Chandrasekhar, Usman Baber, Samantha Sartori, Giulio G. Stefanini, Michele Sarin, Birgit Vogel, Serdar Farhan, Edoardo Camenzind, Martin B. Leon, Gregg W. Stone, Patrick W. Serruys, William Wijns, Philippe G. Steg, Giora Weisz, Alaide Chieffo, Adnan Kastrati, Stephan Windecker, Marie-Claude Morice, Pieter C. Smits, Clemens von BirgelenGhada W. Mikhail, Dipti Itchhaporia, Laxmi Mehta, Hyo-Soo Kim, Marco Valgimigli, Raban V. Jeger, Takeshi Kimura, Søren Galatius, David E. Kandzari, George D. Dangas, Roxana Mehran*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives: The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES).

Background: In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear.

Methods: Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, or target lesion revascularization.

Results: In the per-patient analysis, a stepwise increase was observed with increasing stent length in the adjusted risk for 3-year MACE (p for trend <0.0001), myocardial infarction (p for trend <0.001), cardiac death (p for trend = 0.038), and target lesion revascularization (p for trend = 0.011) but not definite or probable stent thrombosis (p for trend = 0.673). In the per-lesion analysis, an increase was observed in the adjusted risk for 3-year MACE (p for trend = 0.002) and myocardial infarction (p for trend <0.0001) but not other individual endpoints. On landmark analysis for late event rates between 1 and 3 years, stent length per patient demonstrated weak associations with target lesion revascularization (p = 0.0131) and MACE (p = 0.0499), whereas stent length per lesion was not associated with higher risk for any late events, suggesting that risk was established early within the first year after PCI.

Conclusions: In this pooled analysis of women undergoing PCI with new-generation DES, increasing stent length per patient and per lesion were independent predictors of 3-year MACE but were not associated with definite or probable stent thrombosis.

Original languageEnglish
Pages (from-to)53-65
Number of pages13
JournalJACC : cardiovascular interventions
Volume11
Issue number1
DOIs
Publication statusPublished - 8 Jan 2018
Externally publishedYes

Keywords

  • New-generation drug-eluting stents
  • Patient-level pooled analysis of women
  • Percutaneous coronary intervention
  • Stent length per lesion
  • Stent length per patient

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