Impact of the ultra‐long 48 mm drug‐eluting stent on procedural and clinical outcomes in patients with diffuse long coronary artery disease

BACKGROUND: Diffuse coronary artery disease (CAD) is a prognostic factor after percutaneous coronary intervention (PCI) and requires multiple overlapping stent implantations. HYPOTHESIS: We investigated the impact of ultra‐long 48 mm drug‐eluting stent (DES) on procedural and clinical outcomes in real‐world practice. METHODS: Patients who underwent DES implantation for a lesion length of >40 mm were selected from a prospective registry between 2019 and 2021. Patients treated with one or more ultra‐long 48 mm DES were in the ultra‐long DES group (n = 221). The others comprised the conventional DES group (n = 428). Procedural and clinical outcomes were compared after propensity score matching (PSM). The primary endpoint was a device‐oriented composite outcome (DOCO) consisting of cardiac death, target vessel‐related myocardial infarction, and target lesion revascularization at 1‐year follow‐up. RESULTS: After PSM, 158 matched pairs of patients showed no differences in the baseline clinical and angiographic characteristics. The stent delivery failure rate, the use of guide‐extension catheter or anchor balloon technique, and the procedural success rate were similar for both groups. Approximately two‐thirds of lesions could be treated with one DES in the ultra‐long DES group. At 1‐year follow‐up, the DOCO was similar for both groups (2.5% vs. 0.6%, p = .168). CONCLUSIONS: In daily clinical practice, ultra‐long DES implantation is as safe and effective as multiple overlapping conventional DES implants in treating diffuse long CAD. However, ultra‐long DES can reduce the number of stents. (Trial Registration: ClinicalTrials.gov Identifier: NCT02038127).