Multiple overlapping
drug-eluting stents have increasingly been used to treat diffuse
coronary disease, but the safety and efficacy of this approach remains unclear. We assayed the clinical and angiographic outcomes after placement of "full
metal jacket"
stents (stented length >or=60 mm) in 347 consecutive patients (352 lesions) with very long de novo coronary lesions. Mean age was 61.0 +/- 10.1 years, and the mean stented length was 71.9 +/- 13.7 mm. The procedural success rate was 97.7%. Major in-hospital complications (1 death, 2 cases of acute
stent thrombosis) occurred in 3 patients (0.7%). Angiographic follow-up data, obtained for 230 (234 lesions) of the 328 eligible patients (70.1%), showed that the restenosis rate was 13.7%. Multivariate analysis found that the reference artery diameter (odds ratio 0.05, 95% confidence interval [CI] 0.01 to 0.33, p = 0.002) and the use of Taxus
stents (odds ratio 2.88, 95% CI 1.03 to 8.04, p = 0.043) were significant predictors of restenosis. During follow-up (16.6 +/- 6.9 months), 9 deaths (6 cardiac and 3 noncardiac), 1 nonfatal
myocardial infarction, and 13 target lesion revascularizations occurred. The cumulative probability of survival without
major adverse cardiac events (
cardiac death, Q-wave
myocardial infarction, and target lesion revascularization) was 95.4 +/- 1.1% and 91.4 +/- 2.1% at 1 and 2 years, respectively.
Left ventricular dysfunction (ejection fraction <45%) was the only predictor of
stent thrombosis (hazard ratio 18.24, 95% CI 1.65 to 201.19, p = 0.018) and
cardiac death/Q-wave
myocardial infarction (hazard ratio 5.37, 95% CI 1.28 to 22.49, p = 0.021). In conclusion, full
metal jacket
drug-eluting stents may be a safe and effective method to treat diffuse
coronary disease and may be a useful treatment option for complex long lesions.