Relationship between stent length and very long-term target lesion failure following percutaneous coronary intervention for ST-elevation myocardial infarction in the drug-eluting stents era: insights from the EXAMINATION-EXTEND study - 13/09/23

Doi : 10.1016/j.ahj.2023.05.021

Kamil Bujak, MD ^a,^b, Pablo Vidal-Cales, MD ^a, Rami Gabani, MD ^a, Riccardo Rinaldi, MD ^a,^c, Josep Gomez-Lara, MD, PhD ^d, Luis Ortega-Paz, MD, PhD ^a,^e, Victor Jimenez-Diaz, MD, PhD ^f, Marcelo Jimenez-Kockar, MD ^g, Pilar Jimenez-Quevedo, MD, PhD ^h, Roberto Diletti, MD, PhD ⁱ, Gianluca Campo, MD, PhD ^j, Antonio Silvestro, MD ^k, Jaume Maristany, MD, PhD ^l, Xacobe Flores, MD, PhD ^m, Loreto Oyarzabal, MD ^d, Antonio De Miguel-Castro, MD ^f, Andrés Iñiguez, MD, PhD ^f, Luis Nombela-Franco, MD, PhD ^h, Alfonso Ielasi, MD, PhD ^k, Maurizio Tespili, MD, PhD ^k, Mattie Lenzen, MD, PhD ⁱ, Simone Biscaglia, MD ^j, Soheil Al-Shaibani, MD ⁱ, Rafael Romaguera, MD ^d, Joan Antoni Gomez-Hospital, MD, PhD ^d, Mariusz Gasior, MD, PhD ^b, Patrick W. Serruys, MD, PhD ^n,^o, Manel Sabate, MD, PhD ^a, Salvatore Brugaletta, MD, PhD ^a,^⁎
^a Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
^b 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
^c Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
^d Hospital Universitari de Bellvitge, Institut d´Investigació Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
^e Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL
^f Hospital Alvaro Cunqueiro, Vigo, Spain
^g University Hospital of Sant Pau, Barcelona, Spain
^h University Hospital San Carlos, Madrid, Spain
ⁱ Erasmus University Medical Center, Rotterdam, The Netherlands
^j Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona, Italy
^k University Hospital Bolognini Seriate; Bergamo; Italy
^l Hospital Son Espases, Palma de Mallorca, Spain
^m Hospital Universitario, A Coruña, Spain
ⁿ International Center of Circulatory Health, Imperial College London, London, United Kingdom
^o Department of Cardiology, National University of Ireland, Galway, Galway, Ireland

^⁎Reprint requests: Salvatore Brugaletta, MD, PhD, Department of Cardiology, Hospital Clinic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Villarroel 170, Barcelona 08036, Spain.Department of CardiologyHospital ClinicCardiovascular Clinic InstituteInstitut d'Investigacions Biomèdiques August Pi i SunyerUniversity of BarcelonaVillarroel 170Barcelona08036Spain

Résumé

Background

Little data exist on the relationship between total stent length (TSL) and cardiovascular outcomes at very-long follow-up in patients with ST-elevation myocardial infarction (STEMI) in the 2nd generation drug-eluting stents (DES) era.

Aim

To analyze the relationship between TSL and 10-year target-lesion failure (TLF) in STEMI patients treated with percutaneous coronary intervention enrolled in the EXAMINATION-EXTEND.

Methods

The EXAMINATION-EXTEND was an extended-follow-up study of the EXAMINATION trial, which randomized 1:1 STEMI patients to receive DES or bare metal stent (BMS). The primary endpoint was TLF, defined as a composite of target lesion revascularization (TLR), target vessel myocardial infarction (TVMI), or definite/probable stent thrombosis (ST). Relationship between stent length and TLF was evaluated in the whole study group in a multiple-adjusted Cox regression model with TSL as a quantitative variable. Subgroup analysis was also performed according to stent type, diameter, and overlap.

Results

A total of 1,489 patients with a median TSL of 23 mm (Q1-Q318-35 mm) were included. TSL was associated with TLF at 10 years (adjusted HR per 5 mm increase of 1.07; 95% CI, 1.01-1.14; P = .02). This effect was mainly driven by TLR and was consistent regardless of stent type, diameter, or overlap. There was no significant relationship between TSL and TV-MI or ST.

Conclusions

In STEMI patients, there is a direct relationship between TSL implanted in the culprit vessel and the risk of TLF at 10 years, mainly driven by TLR. The use of DES did not modify this association.

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Plan

Methods

Study design and patients

Endpoints and follow-up

Statistical analysis

Results

Study population

Incidence of primary and secondary outcomes

The comparison of BMS vs DES in subgroups by stent length

Landmark analysis

Cox regression models with total stent length as a quantitative variable

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Vol 264

P. 72-82 - octobre 2023 Retour au numéro

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Relationship between stent length and very long-term target lesion failure following percutaneous coronary intervention for ST-elevation myocardial infarction in the drug-eluting stents era: insights from the EXAMINATION-EXTEND study - 13/09/23

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