Long-Term Cardiovascular Outcomes Following Percutaneous Coronary Intervention of Diffuse Coronary Artery Lesions With Overlapping Homogeneous Versus Heterogeneous Second-Generation Drug-Eluting Stents.
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Senguttuvan Nagendra Boopathy, Salahuddin Salman, Abdulkader Rizwan Suliankatchi, Gunasekar Swetharajan, Narayanan Dharaneswari Hari, Kumar Pavitraa Saravana, Mohanan Sandeep, Mahesh Keerthana Vaishnavi, Ganesh Monisha, Prabhakaran Kavitha, Thota Mohan Kumar, Karthikeyan Gautam Ganesan, Ramesh Aravind, Ramachandran Pavithra, Begam Benasir, Lakshmanan Gokulalakshmi, Ravi Thrisha, Chidambaram Yogapriya, Kasi Madhesh, Anandaram Asuwin, Prashanth Akshay, Arul Judah Nijas, Krishnamurthy Preetam, Balasubramaniyan Jayanty Venkata, Balakrishnan Vinod Kumar, Shanmugasundaram Sadhanandham, Ramesh Sankaran, Panchanatham Manokar, Iyer Meena, Murthy Jayanty Satyanarayana, Muralidharan Thoddi Ramamurthy, Thanikachalam Sadagopan
Аннотация
METHODS AND RESULTS: We conducted a retrospective observational cohort study at two high-volume, tertiary cardiac care centers in India to determine the safety and efficacy of homogeneous overlapping stents (HOSTs) and heterogeneous overlapping stents (HESTs) in patients with dCAD undergoing percutaneous coronary intervention (PCI). Patients were stratified into complex and non-complex subgroups based on pre-specified clinical and angiographic criteria. Out of 12,920 interventions that were performed during the study period (January 2016 to December 2023), 972 procedures utilized overlapping stent strategies, of which 935 cases met the inclusion and exclusion criteria. HOSTs were used in 795 patients, while HESTs were used in 140 patients. To account for imbalances in the study population, inverse probability of treatment weighting (IPTW) was applied following propensity score adjustment via logistic regression modeling. During a mean follow-up of 2.5 years, occurrence of major adverse cardiovascular events (MACE) was comparable between HOST and HEST groups in the unadjusted (odds ratio [OR] 0.91, 95% confidence interval [CI]: 0.59-1.42, p = 0.67), as well as adjusted population (OR 1.05, 95% CI: 0.69-1.61, p = 0.81). Similar trends were observed in the complexity-stratified populations, with no evidence of benefit or harm associated with either stenting strategy.
CONCLUSION: Overlapping heterogeneous stents yield similar clinical outcomes as homogeneous stents, regardless of procedural complexity, suggesting that operators may use a "mix-and-match" strategy when ideal stent pairings are not feasible.