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OBJECTIVES: We compared the angiographic and long-term clinical outcomes of patients with and without overlap of drug-eluting stents (DES). BACKGROUND: DES overlap has been associated with delayed healing and increased inflammation in experimental studies, but its impact on clinical outcome is not well established. METHODS: We analyzed the angiographic and clinical outcomes of 1,012 patients treated with DES in the SIRTAX (Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization) trial according to the presence or absence of stent overlap and the number of stents per vessel: 134 (13.2%) patients with multiple DES in a vessel with overlap, 199 (19.7%) patients with multiple DES in a vessel without overlap, and 679 (67.1%) patients with 1 DES per vessel. RESULTS: Angiographic follow-up at 8 months showed an increased late loss in DES overlap patients (0.33 +/- 0.61 mm) compared with the other groups (0.18 +/- 0.43 mm and 0.15 +/- 0.38 mm, p < 0.01). The smallest minimal lumen diameter was located at the zone of stent overlap in 17 (68%) of 25 patients with stent overlap who underwent target lesion revascularization. Major adverse cardiac events were more common in patients with DES overlap (34 events, 25.4%) than in the other groups (42 events, 21.1% and 95 events, 14.0%) at 3 years (p < 0.01). Both the risk of target lesion revascularization (20.2% vs. 16.1% vs. 9.7%, p < 0.01) and the composite of death or myocardial infarction (17.2% vs. 14.1% vs. 9.1%, p = 0.01) were increased in patients with DES overlap compared with the other groups. CONCLUSIONS: DES overlap occurs in >10% of patients undergoing percutaneous coronary intervention in routine clinical practice and is associated with impaired angiographic and long-term clinical outcome, including death or myocardial infarction. (Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization; NCT00297661).

Original publication

DOI

10.1016/j.jacc.2009.11.052

Type

Journal article

Journal

J Am Coll Cardiol

Publication Date

23/03/2010

Volume

55

Pages

1178 - 1188

Keywords

Acute Coronary Syndrome, Aged, Aged, 80 and over, Angina Pectoris, Angioplasty, Balloon, Coronary, Coronary Angiography, Drug-Eluting Stents, Female, Humans, Male, Time Factors, Treatment Outcome