Overlapping Drug-Eluting Stent Is Associated with Increased Definite Stent Thrombosis and Revascularization: Results fro
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ORIGINAL ARTICLE
Overlapping Drug-Eluting Stent Is Associated with Increased Definite Stent Thrombosis and Revascularization: Results from 15,561 Patients in the AUTHENTIC Study Xiang Chen 1,2 & Xiaofei Gao 1 & Jing Kan 1 & Rajiv Shrestha 1 & Leng Han 3 & Shu Lu 4 & Xuesong Qian 5,6 & Bill D. Gogas 5,6 & Junjie Zhang 1 & Shao-Liang Chen 1 Accepted: 8 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose This study was to analyze the incidence of definite stent thrombosis (ST) after the implantation of drug-eluting stents (DESs) and cutoff value of overlapping length for predicting definite ST. An overlapping stent is associated with a high rate of clinical events after DES implantation compared with a non-overlapping stent. However, the rates of definite ST and clinical outcomes from a large patient population remain underreported. Methods A total of 15,561 patients with 24,183 lesions who underwent DES implantation from January 2005 to February 2017 were retrospectively included in 5 tertiary hospitals in China. The main endpoint was the incidence of definite ST after procedures. Results With a median of 1932 (IQR = 1194–2929) days, clinical follow-up was available in 7484 patients in the overlap group and in 8077 patients in the non-overlap group. The rates of definite ST were 3.1% in the overlap group and 1.2% in the nonoverlap group (HR: 2.67 (95% CI: 2.11–3.38), p < 0.001). Of the 24,183 treated lesions, the incidences of definite ST were 2.4% in the overlap group and 0.9% in the non-overlap group (HR: 2.96 (95% CI: 2.38–3.69), p < 0.001). Stent overlap was associated with a higher rate of target lesion revascularization (TLR) (9.4%) compared with stent non-overlap (6.4%, p < 0.001). The length of overlapping stent ≥ 2.93 mm strongly correlated with definite ST. Conclusion The present study shows that overlapping DES increases definite ST and revascularization in patients during longterm follow-up. In addition, the longer overlapping zone was associated with worse clinical outcomes. Keywords Overlapping stent . Stent thrombosis . Drug-eluting stent . Coronary revascularization
Abbreviations ST Stent thrombosis PCI Percutaneous coronary intervention DES Drug-eluting stent
BMS BVS IVUS MACE
Bare-metal stent Bioresorbable vascular scaffold Intravascular ultrasound Major adverse cardiac event
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07094-7) contains supplementary material, which is available to authorized users. * Junjie Zhang [email protected]
3
Department of Cardiology, Changshu NO.1 People’s Hospital, Changshu, China
* Shao-Liang Chen [email protected]
4
Department of Cardiology, The First People’s Hospital of Taicang, Taicang, China
5
Department of Cardiology, The First People’s Hospital of Zhangjiagang, Zhangjiagang, China
6
Department of Cardiology, Emory University Hospital, Atlanta, GA, USA
1
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Changle Road 68
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