Author + information
- Received February 23, 2017
- Revision received November 16, 2017
- Accepted November 17, 2017
- Published online January 1, 2018.
- Jaya Chandrasekhar, MBBS, MSa,
- Usman Baber, MD, MSa,
- Samantha Sartori, PhDa,
- Giulio G. Stefanini, MD, PhDb,
- Michele Sarin, MSa,
- Birgit Vogel, MDa,
- Serdar Farhan, MDa,
- Edoardo Camenzind, MDc,
- Martin B. Leon, MDd,
- Gregg W. Stone, MDd,
- Patrick W. Serruys, MDe,
- William Wijns, MDf,
- Philippe G. Steg, MDg,
- Giora Weisz, MDd,h,
- Alaide Chieffo, MDi,
- Adnan Kastrati, MDj,
- Stephan Windecker, MDk,
- Marie-Claude Morice, MDl,
- Pieter C. Smits, MDm,
- Clemens von Birgelen, MD, PhDn,
- Ghada W. Mikhail, MD, PhDe,
- Dipti Itchhaporia, MDo,
- Laxmi Mehta, MDp,
- Hyo-Soo Kim, MDq,
- Marco Valgimigli, MD, PhDr,
- Raban V. Jeger, MDs,
- Takeshi Kimura, MDt,
- Søren Galatius, MDu,
- David Kandzari, MDv,
- George Dangas, MD, PhDa and
- Roxana Mehran, MDa,∗ ()
- aThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- bHumanitas Research Hospital, Rozzano, Milan, Italy
- cInstitut Lorrain du Coeur et des Vaisseaux, Vandoeuvre-lès-Nancy, France
- dColumbia University Medical Center, New York, New York
- eImperial College Healthcare NHS Trust, London, United Kingdom
- fCardiovascular Center Aalst, Onze-Lieve-Vrouwziekenhuis Ziekenhuis, Aalst, Belgium
- gDépartement Hospitalo Universitaire, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, INSERM U114, Paris, France
- hShaare Zedek Medical Center, Jerusalem, Israel
- iSan Raffaele Scientific Institute, Milan, Italy
- jDeutsches Herzentrum Munchen, Technische Universitat Munich, Germany
- kBern University Hospital, Bern, Switzerland
- lInstitut Cardiovasculaire Paris Sud, Ramsay Générale de Santé, Massy, France
- mMaasstad Hospital, Rotterdam, the Netherlands
- nThoraxcentrum Twente, Enschede, the Netherlands
- oHoag Memorial Hospital Presbyterian, Newport Beach, California
- pOhio State University Medical Center, Columbus, Ohio
- qSeoul National University Hospital, Seoul, Korea
- rUniversity of Ferrara, Ferrara, Italy
- sUniversity Hospital Basel, Basel, Switzerland
- tKyoto University Graduate School of Medicine, Kyoto, Japan
- uBispebjerg University Hospital, Copenhagen, Denmark
- vPiedmont Heart Institute, Atlanta, Georgia
- ↵∗Address for correspondence:
Dr. Roxana Mehran, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Objectives The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES).
Background In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear.
Methods Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, or target lesion revascularization.
Results In the per-patient analysis, a stepwise increase was observed with increasing stent length in the adjusted risk for 3-year MACE (p for trend <0.0001), myocardial infarction (p for trend <0.001), cardiac death (p for trend = 0.038), and target lesion revascularization (p for trend = 0.011) but not definite or probable stent thrombosis (p for trend = 0.673). In the per-lesion analysis, an increase was observed in the adjusted risk for 3-year MACE (p for trend = 0.002) and myocardial infarction (p for trend <0.0001) but not other individual endpoints. On landmark analysis for late event rates between 1 and 3 years, stent length per patient demonstrated weak associations with target lesion revascularization (p = 0.0131) and MACE (p = 0.0499), whereas stent length per lesion was not associated with higher risk for any late events, suggesting that risk was established early within the first year after PCI.
Conclusions In this pooled analysis of women undergoing PCI with new-generation DES, increasing stent length per patient and per lesion were independent predictors of 3-year MACE but were not associated with definite or probable stent thrombosis.
- new-generation drug-eluting stents
- patient-level pooled analysis of women
- percutaneous coronary intervention
- stent length per lesion
- stent length per patient
This study was supported by a grant from the Women in Innovations initiative of the Society for Cardiovascular Angiography and Interventions. Dr. Mehran has received institutional research grant support from AstraZeneca, Bayer, Beth Israel Deaconess, Bristol Myers-Squibb, CSL Behring, Eli Lilly/Daiichi-Sankyo, Medtronic, Novartis Pharmaceuticals, OrbusNeich; has served as a consultant for Abbott Vascular, American College of Cardiology, AstraZeneca, Boston Scientific, CardioKinetix, CSL Behring, Medscape, Shanghai BraccoSine Pharmaceutical, Spectranetics; has served on the advisory board for Bristol Myers-Squibb; has received institutional advisory board funding from Bristol-Myers Squibb; has received institutional funding from Claret Medical; owns equity in Claret Medical and Elixir Medical; has served on the executive committee for Janssen Pharmaceuticals and Osprey Medical; has served on the data safety monitoring board for Watermark Research Partners; and has a spouse who has served as a consultant for Abiomed and The Medicines Company. Dr. Stefanini has received a research grant (to the institution) from Boston Scientific; and speaking and consulting fees from B. Braun, Biosensors, Boston Scientific, and Edwards Lifesciences. Dr. Steg has received a research grant (to INSERM U1148) from Sanofi and Servier; has received speaking and consulting fees from Amarin, AstraZeneca, Bayer, Boehringer-Ingelheim, Bristol-Myers Squibb, CSL-Behring, Daiichi-Sankyo, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Regeneron, Roche, Sanofi, Servier, and The Medicines Company; and is a stockholder in Aterovax. Dr. Windecker has received research grants to his institution from Abbott Vascular, Biotronik, Boston Scientific, Medtronic, Edwards Lifesciences, and St. Jude Medical. Dr. Wijns has received institutional research grants from Terumo, Abbott Vascular, Biotronik and MicroPort; speaker fees from Biotronik, Abbott Vascular, and MicroPort; and is a co-founder of Argonauts Partners, an innovation facilitator. Dr. Smits has received institutional research grants from Abbott Vascular, Terumo, and St. Jude Medical. Dr. Kandzari has received research and grant support from Abbott Vascular, Biotronik, Boston Scientific, Medtronic CardioVascular, and Medinol; and consulting honoraria from Boston Scientific and Medtronic CardioVascular. Dr. von Birgelen has been an unpaid consultant to various device-manufacturing companies; and his institution, Thoraxcentrum Twente, has received research grants from Abbott Vascular, AstraZeneca, Biotronik, Boston Scientific, and Medtronic. Dr. Weisz is a member of medical advisory boards for Corindus, Angioslide, and Medivisor; and has ownership interest in Filterlex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 23, 2017.
- Revision received November 16, 2017.
- Accepted November 17, 2017.