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Comparison of Long-Term Outcomes Between Second-Generation Single Long Stents and Overlapping Stents for Long-Diffuse
Masaaki Ikehara1,2, Kaoru Hattori2,3,4, Hiroshi Niinami2,3
1Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University Tokyo Japan.
Insights
For long-diffuse coronary artery disease (ldCAD), single long stents (SLS) show similar outcomes to overlapping stents (OLS) with newer drug-eluting stents (DES), with SLS potentially reducing myocardial infarction risk.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Increasing prevalence of coronary artery disease (CAD) in aging populations.
- Long-diffuse CAD (ldCAD), defined by lesions ≥30 mm, presents significant therapeutic challenges.
- Evaluation of treatment strategies for ldCAD using second-generation and later drug-eluting stents (DES).
Purpose of the Study:
- To compare long-term prognostic outcomes between single long stents (SLS) and overlapping stents (OLS) in patients with ldCAD.
- To assess the impact of stent strategy on major adverse cardiovascular events (MACE) and other cardiac events.
- To investigate differences in myocardial infarction (MI) incidence between SLS and OLS strategies.
Main Methods:
- Systematic review and meta-analysis of studies published between 2000 and October 2024.
- Inclusion of studies from PubMed, Embase, Web of Science, and the Cochrane Library.
- Analysis of 5 studies involving 2,756 patients, focusing on MACE, cardiac death, TVR, and MI.
Main Results:
- No significant differences observed between SLS and OLS for MACE and target vessel revascularization (TVR).
- Significantly lower incidence of myocardial infarction (MI) with SLS compared to OLS.
- SLS strategy associated with reduced contrast volume and a trend towards shorter lesion and stent lengths.
Conclusions:
- Stent overlap has minimal impact on prognosis with modern drug-eluting stents (DES).
- Further research is warranted to optimize treatment strategies for ldCAD.
- Clinical practice guidelines may need updates regarding stent selection for ldCAD.
Background:
Coronary artery disease (CAD) is becoming increasingly prevalent in aging populations. Long-diffuse CAD (ldCAD), characterized by lesions ≥30 mm, poses significant treatment challenges. This study aimed to evaluate the long-term prognostic differences between single long stents (SLS) and overlapping stents (OLS) in patients with ldCAD using second-generation and later drug-eluting stents (DES).
Methods And Results:
A systematic review and meta-analysis of studies published between 2000 and October 2024 in PubMed, Embase, Web of Science, and the Cochrane Library was conducted. The primary outcome was major adverse cardiovascular events (MACE) over 1 year. The secondary outcomes were cardiac death, target lesion revascularization, target vessel revascularization (TVR), and fatal or non-fatal myocardial infarction (MI). The analysis included 5 studies with 2,756 patients, indicating no significant differences between SLS and OLS regarding MACE and TVR. However, MI incidence was significantly lower with SLS, whereas OLS showed a higher MI incidence, likely due to differences in lesion length rather than the strategy itself. Subanalyses indicated that SLS significantly reduced contrast volume compared with OLS, with a trend toward shorter lesions and stent lengths.
Conclusions:
Stent overlap has minimal impact on prognosis with newer DES. Despite limitations from non-randomized data, further research is needed to optimize ldCAD treatment strategies and guide clinical practice.
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