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Original Articles

Long-Term Follow-Up on a Large Cohort of "Full-Metal Jacket" Percutaneous Coronary Intervention Procedures

Andrew S.P. Sharp, MBChB; Azeem Latib, MBBCh; Alfonso Ielasi, MD; Claudio Larosa, MD; Cosmo Godino, MD; Marta Saolini, MD; Valeria Magni, MD; Robert T. Gerber, PhD; Matteo Montorfano, MD; Mauro Carlino, MD; Iassen Michev, MD; Alaide Chieffo, MD and Antonio Colombo, MD

From the San Raffaele Scientific Institute and EMO-GVM Centro Cuore, Columbus Hospital, Milan, Italy; (A.S.P.S., A.L., A.I., C.L., C.G., M.S., V.M., R.T.G., M.M., M.C., I.M., A.C., A.C.) and Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, United Kingdom (A.S.P.S.).

Correspondence to Andrew S.P. Sharp, MBChB, EMO-GVM Centro Cuore Columbus, Via Buonarroti, Milan 20145, Italy. E-mail andrewsharp{at}doctors.net.uk

Received June 15, 2009; accepted August 21, 2009.

Background— Limited long-term data exist on patients who have undergone drug-eluting stenting of very long lesions (requiring 60 mm of continuous stent) in native coronary arteries ("full-metal jacket").

Methods and Results— We examined consecutive procedures taking place between March 2002 and 2007 at 2 high-volume centers in Milan, Italy. Exclusion criteria were percutaneous coronary intervention for restenosis, percutaneous coronary intervention to a bypass graft, or percutaneous coronary intervention for acute ST-elevation myocardial infarction (MI). We identified 658 full-metal jacket lesions in 617 patients. Average age of the cohort was 62.0±10.6; 32.8% were diabetic, 51.5% had a previous MI, and 33.4% had undergone a previous percutaneous transluminal coronary angioplasty. Mean ejection fraction was 52.1±10.4%. The lesion was a chronic total occlusion in 33.0%. Median duration of clinical follow-up was 39 months (interquartile range, 28 to 50). Six-month follow-up was achieved in 97% of patients; 2-year follow-up was achieved in 91%. All-cause mortality rate was 7.3%; cardiac death rate was 3.6%. Non–procedure-related MI rates were 3.5%. Target lesion revascularization rates were 23.4%. There were 17 cases of Academic Research Consortium–defined definite or probable stent thrombosis (2.6%): 5 acute, 2 subacute, 6 late, and 4 very late. Ten of the 17 cases occurred while the patient was receiving dual antiplatelet therapy; 4 of the 17 after premature termination of 1 or both antiplatelets, and 3 of the 17 occurred while the patient was receiving single-antiplatelet therapy, after having completed the prescribed course of dual antiplatelet therapy.

Conclusion— When very long lesions (60 mm) were treated using overlapping drug-eluting stents, 23.4% required a further procedure for restenosis at 3-year follow-up. However, MI, stent thrombosis, and cardiac mortality rates were relatively low.

Key Words: full-metal jacket • long lesions • DES • outcomes

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