pISSN 1738-5520 eISSN 1738-5555
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Open Access, Peer-reviewed, Monthly
    Korean Circ J. 2008 Nov;38(11):612-617. Korean.
    Published online Nov 30, 2008.
    https://doi.org/10.4070/kcj.2008.38.11.612
    Copyright © 2008 The Korean Society of Cardiology
    Original Article

    Impact of Drug-Eluting Stents on Clinical Outcomes in Patients With Diffuse Coronary Lesions

    Hyeon Gook Lee, MD,1 Kook Jin Chun, MD,2 Kyoung Im Cho, MD,1 Dong Won Lee, MD,1 Jun Hyuk Oh, MD,2 Byung Jae Ahn, MD,2 Seong Ho Kim, MD,2 Joon Sang Lee, MD,2 Moo Young Kim, MD,2 Woo Hyung Bae, MD,2 Woo Seog Ko, MD,2 Joon Hoon Jeong, MD,2 Tae Ik Kim, MD,1 Han Cheol Lee, MD,2 Jun Kim, MD,2 June Hong Kim, MD,2 Taek Jong Hong, MD,2 and Yung Woo Shin, MD2
      • 1Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea.
      • 2Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, Busan, Korea.
    • Correspondence: Kook Jin Chun, MD, Division of Cardiology, Department of Internal Medicine, College of Medicine, Pusan National University, 10 Ami-dong 1-ga, Seo-gu, Busan 602-739, Korea. Tel: 82-51-240-7794, Fax: 82-51-240-7796, Email: ptca82@hotmail.com
    Received October 05, 2005; Revised July 24, 2008; Accepted August 21, 2008.

    Abstract

    Background and Objectives

    In the era of stents, lesion length remains an important predictor of restenosis. Drug-eluting stents (DESs) have significantly reduced in-stent restenosis (ISR), but results in long lesions are still lacking. Therefore, we investigated the impact of DESs on clinical outcomes in patients with diffuse coronary lesions.

    Subjects and Methods

    Between January 2004 and January 2005, 80 patients (94 lesions) with lesions >20 mm in length were treated with one or more DESs and underwent follow-up coronary angiography. The patients were divided into three groups: Group 1 was composed of those with lesions 21 to 35 mm in length, Group 2 was composed of those with lesions 36 to 50 mm in length, and Group 3 was composed of those with lesions ≥51 mm in length.

    Results

    The mean clinical follow-up duration was 9 months. On the 6-month follow-up angiogram, 6.4% of the lesions had binary ISR (5.0% in group 1, 8.7% in group 2, and 9.1% in group 3). The percent diameter stenosis was 6.0±18.15% in Group 1, 12.61±21.99% in Group 2, and 19.81±31.26% in Group 3(p< 0.05). Late lumen loss was 0.17±0.50 mm in Group 1, 0.39±0.66 mm in Group 2, and 0.59±0.93 mm in Group 3 (p<0.05). Lesion length was associated with an increase in percent diameter stenosis and late lumen loss (of 6.9% and 0.21 mm per 15 mm).

    Conclusion

    DES implantation is considered safe and effective in the treatment of diffuse lesions. However, lesion length may be associated with an increase in percent diameter stenosis and late lumen loss at 6-month follow-up.

    Keywords
    Coronary stenosis; Drug-eluting stents; Coronary restenosis

    Figures

    Fig. 1
    Percent diameter stenosis among the 3 groups. Group 1 was composed of those patients who had lesions 21 to 35 mm in length, Group 2 was composed of those who had lesions 36 to 50 mm in length, and Group 3 was composed of those who had lesions ≥51 mm in length. *p<0.05. DS: diameter stenosis.

    Fig. 2
    Late lumen loss based on quantitative coronary angiography among the 3 groups. Group 1 was composed of those patients who had lesions 21 to 35 mm in length, Group 2 was composed of those who had lesions 36 to 50 mm in length, and Group 3 was composed of those who had lesions ≥51 mm in length. *p<0.05.

    Tables

    Table 1
    Baseline characteristics and nine-month outcomes

    Table 2
    Angiographic characteristics at baseline and after procedure

    Table 3
    Nine-month follow-up angiographic characteristics

    References

      1. Gruentzig AR, Senning A, Siegenthaler WE. Non-operative dilatation of coronary artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med 1979;301:61–68.
      1. Popma JJ, Califf RM, Topol EJ. Clinical trials of restenosis after coronary angioplasty. Circulation 1991;84:1426–1436.
      1. Kim KH, Jeong MH, Hong SN, et al. The clinical effects of drug-eluting stents for the treatment of coronary in-stent restenosis. Korean Circ J 2005;35:443–447.
      1. Serruy PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon-expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994;331:489–495.
      1. Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994;331:496–501.
      1. Holmes DR Jr, Leon MB, Moses JW, et al. Analysis of 1-year clinical outcomes in the SIRIUS trial: a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation 2004;109:634–640.
      1. Bauters C, Hubert E, Prat A, et al. Predictors of restenosis after coronary stent implantation. J Am Coll Cardiol 1998;31:1291–1298.
      1. Kim YH, Park SW, Cheong SS, et al. Long stent implantation in long coronary lesions: immediate and follow-up results. Korean Circ J 1998;28:902–908.
      1. Kastrati A, Schomig A, Elezi S, et al. Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol 1997;30:1428–1436.
      1. Seung KB. Drug eluting stent and percutaneous coronary intervention. Korean Circ J 2003;33:857–860.
      1. Lemos PA, Serruys PW, van Domburg RY, et al. Unrestricted utilization of sirolimus-eluting stents compared with conventional bare stent implantation in the "real world". Circulation 2004;109:190–195.
      1. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003;349:1315–1323.
      1. Stone GW, Ellis SG, Cox DA, et al. A polymerbased, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 2004;350:221–231.
      1. Colombo A, De Gregorio J, Moussa I, et al. Intravascular ultrasound-guided percutaneous transluminal coronary angioplasty with provisional spot stenting for treatment of long coronary lesions. J Am Coll Cardiol 2001;38:1427–1433.
      1. Warth D, Leon MB, O'Neill W, Zacca N, Polissar NL, Buchbinder M. Rotational atherectomy multicenter registry: acute results, complications and 6-month angiographic follow-up in 709 patients. J Am Coll Cardiol 1994;24:641–648.
      1. Appelman YE, Piek JJ, Strikwerda S, et al. Randomised trial of excimer laser angioplasty versus balloon angioplasty for treatment of obstructive coronary artery disease. Lancet 1996;347:79–84.
      1. Serruys PW, Foley DP, Suttorp MJ, et al. A randomized comparison of the value of additional stenting after optimal balloon angioplasty for long coronary lesion: final results of the additional value of NIR stents for treatment of long coronary lesion (ADVANCE) study. J Am Coll Cardiol 2002;39:393–399.
      1. Mauri L, O'Malley AJ, Popma JJ, et al. Comparison of thrombosis and restenosis risk from stent length of sirolimus-eluting stents versus bare metal stents. Am J Cardiol 2005;95:1140–1145.
      1. Mehran R, Dangas G, Abizaid AS, et al. Angiographic patterns of in-stent restenosis: classification and implications for long-term outcomes. Circulation 1999;100:1872–1878.
      1. Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002;346:1773–1780.
      1. De Scheerder IK, Wang K, Kostopoulos K, Dens J, Desmet W, Piessens JH. Treatment of long dissections by use of a single long or multiple short stents: clinical and angiographic follow-up. Am Heart J 1998;136:345–351.
      1. Hoffmann R, Herrmann G, Silber S, et al. Randomised comparison of success and adverse event rates and cost effectiveness of one long versus two short stents for treatment of long coronary narrowings. Am J Cardiol 2002;90:460–464.
      1. Lee SH, Jang Y, Oh SJ, et al. Overlapping versus one long stenting in long coronary lesions. Catheter Cardiovasc Interv 2004;62:298–302.
      1. Degertekin M, Arampatzis CA, Lemos PA, et al. Very long sirolimus-eluting stent implantation for de novo coronary lesions. Am J Cardiol 2004;93:826–829.
      1. Kerr AJ, Stewart RA, Low CJ, Restieaux NJ, Wilkins GT. Long stenting in native coronary arteries: relation between vessel size and outcome. Cathet Cardiovasc Diagn 1998;44:170–174.
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    MeSH Terms
    Constriction, Pathologic
    Coronary Angiography
    Coronary Restenosis
    Coronary Stenosis
    Drug-Eluting Stents
    Follow-Up Studies
    Humans
    Stents
    Metrics
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