Percutaneous Coronary Intervention using a Full Metal Jacket with Drug-eluting Stents: Major Adverse Cardiac Events at One Year

Background

The clinical benefit of percutaneous coronary intervention (PCI) for long coronarylesions is unclear; furthermore, concerns have been raised about its safety.

Objectives

To evaluate the predictors of major adverse cardiac events (MACE) associated withPCI using a full metal jacket (FMJ), defined as overlapping drug-eluting stents(DES) measuring > 60 mm in length, for very long lesions.

Methods

We enrolled 136 consecutive patients with long coronary lesions requiring FMJ inour single-center registry. The primary endpoint included the combined occurrenceof all-cause death, myocardial infarction (MI), and target vesselrevascularization (TVR). Demographic, clinical, angiographic, and proceduralvariables were evaluated using stepwise Cox regression analysis to determineindependent predictors of outcome.

Results

The mean length of stent per lesion was 73.2 ± 12.3 mm and the mean referencevessel diameter was 2.9 ± 0.6 mm. Angiographic success was 96.3%. Freedom fromMACE was 94.9% at 30 days and 85.3% at one year. At the one-year follow-up, theall-cause mortality rate was 3.7% (1.5% cardiac deaths), the MI rate was 3.7%, andthe incidence of definite or probable stent thrombosis (ST) was 2.9%. Femalegender [hazard ratio (HR), 4.40; 95% confidence interval (CI), 1.81-10.66; p =0.001) and non-right coronary artery PCI (HR, 3.49; 95%CI, 1.42-8.59; p = 0,006)were independent predictors of MACE at one year. Freedom from adverse events atone year was higher in patients with stable angina who underwent PCI (HR, 0.33;95%CI, 0.13-0.80; p = 0.014).

Conclusions

PCI using FMJ with DES for very long lesions was efficacious but associated with ahigh rate of ST at the one-year follow-up. However, the rate of cardiac mortality,nonprocedure-related MI, and MACE was relatively low. Target coronary vessel PCI,clinical presentation, and female gender are new contemporary clinical factorsthat appear to have adverse effects on the outcome of PCI using FMJ for longlesions.