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Published on: May 14, 2013
Long-Term Cardiovascular Outcomes Following Percutaneous Coronary Intervention of Diffuse Coronary Artery Lesions
Nagendra Boopathy Senguttuvan1, Salman Salahuddin2, Rizwan Suliankatchi Abdulkader3
1Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Insights
Using the same or different overlapping stents for diffuse coronary artery disease (dCAD) shows similar safety and effectiveness. This allows for flexible stent selection during percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Diffuse coronary artery disease (dCAD) is increasingly prevalent and severe.
- Optimal stenting techniques are crucial for complete lesion coverage in dCAD.
- Evidence comparing homogeneous and heterogeneous overlapping stents in dCAD is inconclusive.
Purpose of the Study:
- To evaluate the safety and efficacy of homogeneous overlapping stents (HOSTs) versus heterogeneous overlapping stents (HESTs) in dCAD patients undergoing percutaneous coronary intervention (PCI).
- To compare outcomes between HOSTs and HESTs in both complex and non-complex PCI subgroups.
Main Methods:
- Retrospective observational cohort study at two Indian tertiary cardiac centers.
- Included 935 patients with dCAD undergoing PCI with overlapping stents (January 2016-December 2023).
- Used inverse probability of treatment weighting (IPTW) for propensity score adjustment.
Main Results:
- Major adverse cardiovascular events (MACE) were comparable between HOST (795 patients) and HEST (140 patients) groups after a mean 2.5-year follow-up.
- No significant difference in MACE was observed in unadjusted (OR 0.91) or adjusted (OR 1.05) analyses.
- Outcomes were similar across complex and non-complex PCI subgroups, with no identified benefit or harm for either strategy.
Conclusions:
- Overlapping heterogeneous stents demonstrate similar clinical outcomes to homogeneous stents in dCAD patients.
- Procedural complexity does not alter the comparable safety and efficacy of HOSTs and HESTs.
- A "mix-and-match" stenting strategy is feasible when ideal stent pairings are unavailable.
Background And Aims:
The growing prevalence and severity of diffuse coronary artery disease (dCAD) necessitate the utilization of appropriate stenting techniques to ensure complete target lesion coverage. In clinical settings where overlapping stents are the norm, there is inconclusive evidence to determine whether using stents of the same identity produces better outcomes compared to stents that differ in material characteristics.
Methods And Results:
We conducted a retrospective observational cohort study at two high-volume, tertiary cardiac care centers in India to determine the safety and efficacy of homogeneous overlapping stents (HOSTs) and heterogeneous overlapping stents (HESTs) in patients with dCAD undergoing percutaneous coronary intervention (PCI). Patients were stratified into complex and non-complex subgroups based on pre-specified clinical and angiographic criteria. Out of 12,920 interventions that were performed during the study period (January 2016 to December 2023), 972 procedures utilized overlapping stent strategies, of which 935 cases met the inclusion and exclusion criteria. HOSTs were used in 795 patients, while HESTs were used in 140 patients. To account for imbalances in the study population, inverse probability of treatment weighting (IPTW) was applied following propensity score adjustment via logistic regression modeling. During a mean follow-up of 2.5 years, occurrence of major adverse cardiovascular events (MACE) was comparable between HOST and HEST groups in the unadjusted (odds ratio [OR] 0.91, 95% confidence interval [CI]: 0.59-1.42, p = 0.67), as well as adjusted population (OR 1.05, 95% CI: 0.69-1.61, p = 0.81). Similar trends were observed in the complexity-stratified populations, with no evidence of benefit or harm associated with either stenting strategy.
Conclusion:
Overlapping heterogeneous stents yield similar clinical outcomes as homogeneous stents, regardless of procedural complexity, suggesting that operators may use a "mix-and-match" strategy when ideal stent pairings are not feasible.
