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Sticchi A, Tatali C, Ferraro M, Khokhar AA, Scoccia A, Cereda A, Toselli M, Gallo F, Laricchia A, Mangieri A, Grigioni F, Ussia GP, Giannini F, Colombo A. Long Stent Implantation on the Left Anterior Descending Coronary Artery at a Follow-Up of More Than Five Years. J Clin Med 2023; 13:210. [PMID: 38202217 PMCID: PMC10779530 DOI: 10.3390/jcm13010210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Stent implantation represents the standard of care in coronary intervention. While a short stent implanted on a focal lesion located on the left anterior descending artery (LAD) seems a reasonable alternative to an internal mammary implant, the same for long stents is still debated. METHODS We reported the long-term data of 531 consecutive patients who underwent Percutaneous Coronary Intervention (PCI) with long stents in two highly specialized centres. The main inclusion criteria were the implantation of stents longer than 30 mm on the LAD and a minimum follow-up (FU) of five years. The primary endpoint was mortality, and the secondary endpoints were any myocardial infarction (MI), target vessel and lesion revascularization (TVR and TLR, respectively), and stent thrombosis (ST) observed as definite, probable, or possible. RESULTS In this selected population with characteristics of complex PCI (99.1%), the long-term follow-up (mean 92.18 ± 35.5 months) estimates of all-cause death, cardiovascular death, and any myocardial infarction were 18.3%, 10.5%, and 9.3%, respectively. Both all-cause and cardiovascular deaths are significantly associated with three-vessel disease (HR 6.8; confidence of interval (CI) 95% 3.844-11.934; p < 0.001, and HR 4.7; CI 95% 2.265-9.835; p < 0.001, respectively). Target lesion (TLR) and target vessel revascularization (TVR) are associated with the presence of three-lesion disease on the LAD (HR 3.4; CI 95% 1.984-5.781; p < 0.001; HR 3.9 CI 95% 2.323-6.442; p < 0.001, respectively). Re-PCI for any cause occurred in 31.5% of patients and shows an increased risk for three-lesion stenting (HR 4.3; CI 95% 2.873-6.376; p < 0.001) and the treatment of bifurcation with two stents (HR 1.6; 95% CI 1.051-2.414; p = 0.028). Stent thrombosis rate at the 5-year FU was 4.4% (1.3% definite; 0.9% probable; 2.1% possible), including a 1.7% rate of very-late thrombosis. The stent length superior to 40 mm was not associated with poor outcomes (all-cause death p = 0.349; cardiovascular death p = 0.855; MI p = 0.691; re-PCI p = 0.234; TLR p = 0.805; TVR p = 0.087; ST p = 0.189). CONCLUSION At an FU of longer than five years, patients treated with stents longer than 30 mm in their LAD showed acceptable procedural results but poor outcomes.
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Affiliation(s)
- Alessandro Sticchi
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Via Paradisa, 2, 56124 Pisa, Italy;
- University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy
- Cardiovascular Department, Campus Bio-Medico University Hospital of Rome, 00128 Rome, Italy; (C.T.); (F.G.); (G.P.U.)
| | - Concetta Tatali
- Cardiovascular Department, Campus Bio-Medico University Hospital of Rome, 00128 Rome, Italy; (C.T.); (F.G.); (G.P.U.)
| | - Massimo Ferraro
- Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, 20145 Milan, Italy; (M.F.); (A.C.)
| | - Arif A. Khokhar
- Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Alessandra Scoccia
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Alberto Cereda
- Cardiovascular Department, ASST Santi Paolo Carlo, 20142 Milan, Italy
| | - Marco Toselli
- Department of Interventional Cardiology, GVM Care & Research Maria Cecilia Hospital, 48033 Cotignola, Italy; (M.T.); (F.G.)
| | - Francesco Gallo
- Cardiology Unit, Ospedale dell’Angelo, ULSS3 Serenissima, 30174 Mestre, Italy;
| | | | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy;
| | - Francesco Grigioni
- Cardiovascular Department, Campus Bio-Medico University Hospital of Rome, 00128 Rome, Italy; (C.T.); (F.G.); (G.P.U.)
| | - Gian Paolo Ussia
- Cardiovascular Department, Campus Bio-Medico University Hospital of Rome, 00128 Rome, Italy; (C.T.); (F.G.); (G.P.U.)
| | - Francesco Giannini
- Department of Interventional Cardiology, GVM Care & Research Maria Cecilia Hospital, 48033 Cotignola, Italy; (M.T.); (F.G.)
| | - Antonio Colombo
- Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, 20145 Milan, Italy; (M.F.); (A.C.)
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