Introduction: Very long stent use in the treatment of long coronary lesions has increased in recent years. Everolimus-eluting stents (EES) with a chromium-cobalt platform have shown a lower incidence of clinical restenosis, as well as stent thrombosis, compared to first generation drug-eluting stents.
Hypothesis: This study aims to assess the long term clinical outcomes of patients treated with the 38 mm Xience Prime EES (Abbot Vascular, Santa Clara, CA, USA).
Methods: Between January 2011 and June 2011 all consecutive patients treated with at least one 38 mm Xience Prime EES because of a long coronary lesion at our institution were prospectively included. Patients were followed up over 5 years by clinical observation. The primary endpoint was the rate of major adverse cardiac events (MACE) defined as a composite of cardiac death, nonfatal myocardial infarction, and target vessel revascularization (TVR) at 5 years.
Results: 70 patients with 72 long coronary lesions treated with the 38 mm Xience Prime EES were included. Mean age was 63.4±11.5 years and 45.8 % were diabetics. The majority of patients (51.4 %) presented with unstable angina and 11.1% were patients with ST-elevation myocardial infarction. 68.1 % of patients had ≥ 2 vessels disease. The target lesion was mainly located in the left anterior descending coronary artery (44.5%). The mean reference vessel diameter was 3.1±0.4 mm and the mean target lesion length was 51.7±17.3 mm. In 61.1 % of the cases at least one additional stent was required to be overlapped to the 38 mm one to fully cover the lesion yielding a mean stented segment of 54.1 ±17.5 mm. The radial approach was used in 54.2% of cases. Cumulative MACE rate at 5 years was 16.7 %, with 4.2 % cardiac death, 6.9 % myocardial infarction and 11.1 % TVR. 2 patients had a stent thrombosis (one definite and one probable). The MACE rate did not significantly differ between patients with and without an additional stent implanted overlapping the 38 mm one (15.9 % vs. 17.9 %, p=0.82).
Conclusions: In an unselected real world population with long coronary lesions the use of the 38 mm Xience Prime EES is associated with good clinical outcomes demonstrated by the low MACE rates at 5-year follow up, with no difference in patients with overlapped stents.