Descriptive and prognostic study at 5 years of percutaneous coronary intervention by long active stents ≥ 40 mm

Abstract

The treatment of long coronary lesions often requires long stents, which carries a higher risk of stent thrombosis, restenosis and major adverse cardiac events. Our objective is to evaluate the clinical and angiographic results, immediate, in the medium and in the long-term of the coronary angioplasties with very long active stents ≥ 40 mm. We carried out a retrospective, multicenter, descriptive and prognostic study, during a period of 5 years between January 2015 and January 2020 in four Tunisian centers, including all patients who underwent coronary angioplasty with an active stent ≥ 40 mm in length. Four hundred and eighty patients were included. Our population was at high cardiovascular risk: the mean age was 62.45 years with a sex ratio of 3.40. The most frequent cardiovascular risk factors were as follows: arterial hypertension: 61.1%, diabetes: 56.6% and tobacco: 60.5%. The most common clinical presentation was acute coronary syndromes in 69.70%. The artery most frequently stented with a very long stent was the anterior interventricular artery in 49.4%. The treated lesions were complex: 23.5% were calcified, 8.7% were total chronic occlusions and 25% had bifurcations. The average length of the implanted stents was 47.72 mm. The long coronary lesion required an overlap by a 2nd stent in 16.45% of the interventions. Angiographic and clinical success was observed in 96% and 95% of cases respectively. Seventeen cases of per-procedural complications were recorded during the procedure (3.55%). Angiographic control was only performed during the follow-up in 21.7% of patients. The stent thrombosis rate was 0.83%. The incidence of MACE, TVR and TLR and was 16.3%, 9.2% and 7.9%, respectively. Diabetes appeared to be predictive factors of TLR (survival without TLR at 12 months = 99% vs. 93.7%; P = 0.01). The study of the characteristics lesion showed that ostial lesions and bifurcation lesions are predictive factors for increased TLR (ostial lesion: survival without TLR at 5 years = 78.2% vs. 87.4%; P = 0.001/bifurcation lesion: survival without TLR at 5 years = 84% vs. 92.7%; P = 0.03). Coronary stenoses requiring treatment with long stents are generally associated with high cardiovascular risk and complex atheromatous disease. They can be revascularized with a long active stent (≥ 40 mm) with an acceptable MACE, TLR, TVR and thrombosis rate.