The length of the stent is not an event predictor with the new generation of DES. It is the end of the Spot stenting?

Original title: Impact of the Stent Length on Long-Term Clinical Outcomes Following Newer-Generation Drug-Eluting Stent Implantation. Reference: Ik Jun Choi et al. Am J Cardiol 2014;113:457-464.

Completely cover the lesion with a sufficiently long stent has been the preferred strategy that emerged from drug-eluting stents (DES). However, for the first-generation DES stent length has been a predictor of both; thrombosis and restenosis. New generations of DES show modifications to improve both safety and efficacy, but it is unclear whether this has had any impact on the long-term results when longer stents are used. The COACT (Catholic Medical Center percutaneous Coronary Intervention) registry included 8445 patients from eight centers in Korea between 2004 and 2009 received angioplasty with DES. Patients were divided into 1st generation DES (Cypher and Taxus) and 2nd generation DES (Endeavor Resolute and Xience V and Promus) and according to the length covered by the stent (≥ 32 mm and < 32 mm). The primary end point was a composite of death from any cause, nonfatal myocardial infarction and target vessel revascularization.

Of the total, 4076 (48 %) received Cypher, 2258 (27%) Taxus, 1099 (13 %) Xience or Promus and 1012 (12 %) received Endeavor Resolute. At 3 years follow-up and after adjusting the baseline characteristics long covered by the stent ≥ 32 mm approximately,  was significantly associated with revascularization of the target vessel and definite or probable thrombosis in patients who received 1st generation DES (adjusted hazard 1875, 95% CI 1531-2297, p < 0.001), but on the contrary, significant association between the length of stent implanted and adverse events in patients receiving 2nd generation DES (p = 0.383) was observed.


Length covered by stent could not be associated with long-term adverse events in the new generation of drug-eluting stents unlike what happens with 1st generation drug stents. 

Editorial comment

Since this is a retrospective study, patients who received the 1st generation DES were not contemporaneous to the second generation, so they could be differences, concerning medical treatment for example, not adjusted to perform the analysis. It is also a limitation the lack of data on angiography, which cannot establish a relationship between the length of the injury and the length of the implanted stent.