Influence of stent treatment strategies in the long-term outcome of patients with long diffuse coronary lesions

Abstract

Diffuse coronary lesions (length > 20 mm) are still considered high risk for percutaneous intervention even in the current stent era. We compared the 2-year outcome of patients with long diffuse stenosis treated by three different stent strategies. In addition, we also analyzed the possible factors influencing a favorable late outcome. Our series is constituted by 232 patients with 247 long lesions treated between May 1994 and April 1999; 82 patients received one single long stent (group 1), 71 patients were treated by overlapped multiple stents (group 2), and 79 with multiple nonoverlapped stents (group 3). The mean age was 59 +/- 11 years. There were not significant differences between groups in terms of age, risk factors, clinical presentation, type of lesion, or adjunctive medical therapy. Patients from group 1 had shorter lesions (29 +/- 10 mm) than patients from groups 2 (41 +/- 15 mm) and 3 (36 +/- 14; P < 0.05). Major cardiac events (death, acute myocardial infarction, or repeat revascularization) at 24 +/- 12 months follow-up took place in 39 patients (17%). The probabilities of being free of major events at follow-up were 71%, 78%, and 80% for group 1, 2, and 3 respectively (P = NS). Only three variables were identified as significant predictors of these late events: smaller vessel size, smaller minimal lumen diameter after stenting, and the type of lesion being restenotic as compared with native stenosis. Patients with diffuse lesions treated by single long stents did not have a better late outcome than those who received multiple stents. The best late outcome was observed in those patients who had bigger vessel size, larger poststent lumen dimensions and native lesions, regardless of the stent deployment strategy used.