Spot drug-eluting stenting for long coronary stenoses: long-term results of a randomized clinical study

Preliminary results of a randomized trial have suggested that total lesion coverage with drug-eluting stents (DES) is not necessary in the presence of diffuse disease of nonuniform severity. In the present study, we report long-term results of this trial.

Consecutive, consenting patients with a long (>20 mm) coronary lesion of nonuniform severity and indication for percutaneous coronary intervention were randomized to full stent coverage of the atherosclerotic lesion with multiple, overlapping (full DES group, n = 90) or spot stenting of the hemodynamically significant parts of the lesion only (defined as diameter stenosis > 50%) (spot DES group, n = 89).

At a follow-up of 2-7 years, 30 patients with full DES (33.3%) and 12 patients (13.5%) with spot DES had a major adverse cardiac event (MACE) (P = 0.015). Cox proportional hazard model showed that the risk for MACE was almost 65% lower among patients who were subjected to spot DES compared to those who underwent full DES (HR = 0.35, 95% CI = 0.18-0.68, P = 0.002). This association remained significant even after controlling for age, sex, and lesion length, and the type of stent used (HR = 0.41, 95% CI = 0.20-0.81, P = 0.011).

In the presence of diffuse disease of nonuniform severity, selective stenting of only the significantly stenosed parts of the lesion confers better long-term results compared to total lesion coverage with DES.