Background: Multiple overlapping drug-eluting stents (DESs) have been used increasingly to treat diffuse coronary disease, but the safety and efficacy of this approach remains unclear.
Methods and Results:We assayed clinical and angiographic outcomes after placement of “full metal jacket” stents (stented length ≥ 60mm) in 347 consecutive patients (352 lesions) with very long de novo coronary lesions. The mean age was 61.0±10.1 years, and the mean stented length was 71.9±13.7mm. The procedural success rate was 97.7%. Major in-hospital complications (1 death, 2 acute stent thrombosis) occurred in 3 patients (0.7%). Angiographic follow-up data obtained for 230 (234 lesions) of the 328 eligible patients (70.1%) showed that the restenosis rate was 13.7%. Multivariate analysis found that reference artery diameter (OR 0.05; 95%CI, 0.01-0.33; p=0.002) and use of Taxus stents (OR 2.88; 95% CI, 1.03-8.04; p=0.043) were significant predictors of restenosis. During follow-up (16.6±6.9 months), there were 9 deaths (6 cardiac, 3 noncardiac), 1 nonfatal myocardial infarction, and 13 target lesion revascularizations. The cumulative probability of survival without major adverse cardiac events (cardiac death, Q-wave myocardial infarction and target lesion revascularization) was 95.4±1.1% and 91.4±2.1% at 1 and 2 years, respectively. Left ventricular dysfunction (ejection fraction < 45%) was the only predictor of stent thrombosis (HR 18.24; 95% CI, 1.65-201.19; p=0.018) and cardiac death/Q-wave myocardial infarction (HR 5.37; 95% CI, 1.28-22.49; p=0.021).
Conclusion: full metal jacket DESs may be a safe and effective method to treat diffuse coronary disease and may be a useful treatment option for complex long lesions.
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