Long‐Term Cardiovascular Outcomes Following Percutaneous Coronary Intervention of Diffuse Coronary Artery Lesions With Overlapping Homogeneous Versus Heterogeneous Second‐Generation Drug‐Eluting Stents
Nagendra Boopathy Senguttuvan, Salman Salahuddin, Rizwan Suliankatchi Abdulkader, Swetharajan Gunasekar, Dharaneswari Hari Narayanan, Pavitraa Saravana Kumar, Sandeep Mohanan, Keerthana Vaishnavi Mahesh, Monisha Ganesh, Kavitha Prabhakaran, Mohan Kumar Thota, Gautam Ganesan Karthikeyan, Aravind Ramesh, Pavithra Ramachandran, Benasir Begam, Gokulalakshmi Lakshmanan, Thrisha Ravi, Yogapriya Chidambaram, Madhesh Kasi, Asuwin Anandaram, Akshay Prashanth, Judah Nijas Arul, Preetam Krishnamurthy, Jayanty Venkata Balasubramaniyan, Vinod Kumar Balakrishnan, Sadhanandham Shanmugasundaram, Sankaran Ramesh, Manokar Panchanatham, Meena Iyer, Jayanty Satyanarayana Murthy, Thoddi Ramamurthy Muralidharan, Sadagopan ThanikachalamABSTRACT
Background and Aims
The growing prevalence and severity of diffuse coronary artery disease (dCAD) necessitate the utilization of appropriate stenting techniques to ensure complete target lesion coverage. In clinical settings where overlapping stents are the norm, there is inconclusive evidence to determine whether using stents of the same identity produces better outcomes compared to stents that differ in material characteristics.
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.