Comparison of Full Lesion Coverage versus Spot Drug-Fluting Stent Implantation for Coronary Artery Stenoses

Abstract

Purpose: The aim of this study was to evaluate and compare the long-term clinical outcomes of the spot drug-eluting stent (DES) implantation strategy, which is used to minimize implanted stent length and the number of stents, versus full lesion coverage for treatment of coronary artery stenoses. Materials and Methods: We evaluated 1-year clinical outcomes of 1619 patients with stent implantation for a single coronary lesion. They were divided into two groups: those treated by full lesion coverage (n=1200) and those treated with the spot stenting strategy (n=419). The combined occurrence of 1-year target vessel failure (TVF), including cardiac death, target-vessel related myocardial infarction, or ischemia-driven target-vessel revascularization was evaluated. Results: The spot DES implantation group had a shorter stent length (23.14 +/- 9.70 mm vs. 25.44 +/- 13.24 mm, respectively; p<0.001) and a fewer number of stents (1.09 +/- 0.30 vs. 1.16 +/- 0.41, respectively; p<0.001), even though the average lesion length was similar to the full lesion coverage group (21.36 +/- 10.30 mm vs. 20.58 +/- 10.97 mm, respectively; p=0.206). Spot DES implantation was superior to full DES coverage with respect to 1-year TVF (1.4% vs. 3.3%, p=0.044). Cox proportional hazard model analysis showed that the risk for 1-year TVF was almost 60% lower among patients who received spot DESs compared to those who received full DES coverage after adjustment for other risk factors (HR=0.40, 95% confidence interval=0.17-0.98; p=0.046). Conclusion: Minimizing stent length and the number of stents with overlapping by spot DES implantation may result in reduced rates of 1-year TVF, compared with full DES coverage.