Backgrounds: Coronary long lesion is one of important predictors for a worse outcome after PCI. New DESs generally demonstrated better outcomes than First-generation DESs in a large of proven studies. However, the efficacy and safety of the second generation DESs compared with the first generation ones have not been explored yet in long lesions.
Methods: We analyzed a patient-level pooled registry on 15,280 patients undergoing PCI using DESs from the GRAND-DES Registry (EXCELLENT, RESOLUTE KOREA, HOST-PRIME, HOST-BIOLIMUS and HOST-RESOLINTE); the Korean multicenter Drug-eluting stents registry. The 7,724 patients were enrolled in a long lesion group (lesions≥28mm, excluded with multiple lesions in a vessel). The primary endpoints were Target Lesion Failure (TLF) and definite or probable stent thrombosis at 2 year.
Results: 1,238 patients with long lesion treated with First-generation DESs and 6,486 patients with Second-generation DESs were enrolled. Baseline characteristics including age, gender, coexisting conditions, cardiac risk factors and lesion characteristics were not homogenous. There was no significant difference between First and Second-generation for incidence of TLF (6.5% vs. 6.8%, p = 0.76) and stent thrombosis (1.3% vs. 0.9%, p= 0.15). Stent generation was not a significant independent predictor of TLF (HR: 0.92, 95% CI: 0.73 to 1.18; p= 0.53) and stent thrombosis (HR: 0.84, 95% CI: 0.53 to 1.34; p= 0.47) in long lesions. By propensity score matching we matched 1,056 patients with First-generation and 3,168 patients with Second-generation. There were also no significant differences in TLF (5.9% vs. 6.1%, p= 0.82; HR: 1.06, 95% CI: 0.79 to 1.42; p= 0.69) and stent thrombosis (1.6% vs. 1.2%, p value= 0.35; HR: 0.84, 95% CI: 0.47 to 1.51; p= 0.56).
Conclusions: In patients with long coronary lesions undergoing PCI, there were no significant differences in TLF and definite or probable stent thrombosis between First and Second-generation DESs.