Clinical outcomes of long stent in the drug-eluting stent era: patient-level pooled analysis from the GRAND-DES registry.

AIMS: We aimed to understand the association between stent length and clinical outcomes after percutaneous coronary intervention (PCI) using newer generation drug-eluting stents (DES). METHODS AND RESULTS: We analysed 9,217 patients who underwent stenting for a single lesion, from the GRAND-DES registry, a patient-level pooled registry including 5 Korean multicenter DES registries. The median follow-up duration was 730 days (interquartile range 708 to 752 days). 8,035 patients were classified under the short stent group (≤40mm), and 1,182 under the long stent group (>40mm). The primary endpoint was target lesion failure (TLF). Long stent (>40mm) was significantly associated with higher TLF (IPTW adjusted HR:1.88, 95% CI:1.67-2.13; p<0.001), and definite or probable stent thrombosis (IPTW adjusted HR:2.20, 95% CI:1.51-3.20; p<0.001). In the landmark analysis, the incidence of TLF was significantly higher in long stent during the first 30 days after PCI (log-rank p=0.001), and also after 30 days (log-rank p<0.001). Long stent was associated with a higher risk of early stent thrombosis (log-rank p=0.001), but not with that for late stent thrombosis (log-rank p=0.887). CONCLUSIONS: In the contemporary 2nd generation DES era, stenting longer than 40mm continues to be associated with less favourable clinical outcomes such as TLF, and stent thrombosis.