Impact of stent length and diameter on 10-year mortality in the SYNTAXES trial

Hironori Hara, Masafumi Ono, SYNTAX Extended Survival Investigators, Hideyuki Kawashima, Norihiro Kogame, Michael J. Mack, David R. Holmes, Marie Claude Morice, Piroze M. Davierwala, Friedrich W. Mohr, Daniel J.F.M. Thuijs, Stuart J. Head, Arie Pieter Kappetein, Yoshinobu Onuma, Patrick W. Serruys*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objectives: We investigated the impact of total stent length (TSL) and average nominal stent diameter (ASD) on 10-year mortality after percutaneous coronary intervention (PCI) in the SYNTAXES trial. Background: TSL and ASD in patients treated with PCI are associated with major adverse cardiovascular events. However, the treatment effect of PCI with extensive and/or small stenting as compared with coronary artery bypass grafting (CABG) for complex coronary artery disease has not been fully evaluated. Methods: Impacts on mortality of extensive stenting defined as TSL >100 mm and small stenting as ASD <3 mm were analyzed in 893 PCI patients and were compared to 865 CABG patients. Results: TSL as a continuous variable was significantly associated with 10-year mortality (adjusted hazard ratio [HR], 1.05 [1.01–1.09] per 10 mm increase). PCI patients with extensive stenting had a higher 10 year mortality than CABG patients (adjusted HR, 1.97 [1.41–2.74]) or not- extensive stenting PCI (adjusted HR, 1.94 [1.36–2.77]). Although ASD did not have a significant association with 10 year mortality (adjusted HR, 0.97 [0.85–1.11] per 0.25 mm increase), PCI with small stents was associated with a higher 10 year mortality, compared to CABG (adjusted HR, 1.66 [1.23–2.26]) and PCI performed with large stents (adjusted HR, 1.74 [1.19–2.53]). Patients treated with not-extensive and large stents had similar mortality rates (24.0 versus 23.8%) as those treated with CABG. Conclusions: Extensive and small stenting were associated with higher 10 year mortality, compared with CABG. When patients have to be treated with extensive or small stenting, revascularization with CABG should be preferred.

Original languageEnglish
Pages (from-to)E379-E387
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Issue number3
Publication statusPublished - 5 May 2021

Bibliographical note

Funding Information:
Boston Scientific Corporation; the German Foundation of Heart Research Funding information

Funding Information:
Dr. Hara reports a grant for studying overseas from Japanese Circulation Society and a grant from Fukuda Foundation for Medical Technology. Dr. Mack reports non‐financial support from Edwards Lifesciences, non‐financial support from Medtronic, non‐financial support from Abbott, outside the submitted work. Dr. Morice is CEO and shareholder of CERC, a CRO based in Massy France, outside the submitted work. Dr. Head report to work as employee of Medtronic, outside the submitted work. Dr. Kappetein report to work as employee of Medtronic, outside the submitted work. Dr. Serruys reports personal fees from Biosensors, Micel Technologies, Sinomedical Sciences Technology, Philips/Volcano, Xeltis, and HeartFlow, outside the submitted work. All other authors have no conflict of interest to declare.

Publisher Copyright:
© 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.


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