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

• Published in: The American heart journal Vol. 264; pp. 72 - 82
• Main Authors: Bujak, Kamil, Vidal-Cales, Pablo, Gabani, Rami, Rinaldi, Riccardo, Gomez-Lara, Josep, Ortega-Paz, Luis, Jimenez-Diaz, Victor, Jimenez-Kockar, Marcelo, Jimenez-Quevedo, Pilar, Diletti, Roberto, Campo, Gianluca, Silvestro, Antonio, Maristany, Jaume, Flores, Xacobe, Oyarzabal, Loreto, De Miguel-Castro, Antonio, Iñiguez, Andrés, Nombela-Franco, Luis, Ielasi, Alfonso, Tespili, Maurizio, Lenzen, Mattie, Biscaglia, Simone, Al-Shaibani, Soheil, Romaguera, Rafael, Gomez-Hospital, Joan Antoni, Gasior, Mariusz, Serruys, Patrick W., Sabate, Manel, Brugaletta, Salvatore
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2023; Elsevier Limited
• Subjects: Angioplasty; Blood vessels; Clinical outcomes; Drug delivery; Heart attacks; Implants; Lesions; Medical ethics; Myocardial infarction; Regression models; Stents; Subgroups; Surgical implants; Thromboembolism; Thrombosis; Variables; Spain
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2023.05.021

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. 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. 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. 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. 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.