Overlapping Drug-Eluting Stent Increases Definite Stent Thrombosis And Revascularization: Results From 15,561 Patients In The AUTHENTIC Study

OBJECTIVES This study was to analyze the incidence of definite stent thrombosis(ST)after the implantation of drug-eluting stents(DES)and cutoff value of overlapping length for predicting definite ST.BACKGROUND Overlapping stent is associated with a high rate of clinical events after DES implantation compared with non-overlapping stent.However,the rates of definite ST and clinical outcomes from a large patient population remain underreported.METHODS Of 15,561 patients with 24,183 lesions who underwent DES implantation from January 2005 to February 2017 were retrospectively included in 6tertiary hospitals in China.The primary endpoint was the incidence of definite ST after procedures.RESULTS With median of 1,932(IQR = 1194-2929)days,clinical follow-up was available in 7,484 patients in the Overlap group and in 8,077 patients in the NonOverlap group.The rates of definite ST were 3.1% in the Overlap group and 1.2% in the Non-Overlap group [HR: 2.67(95%CI: 2.11-3.38),p < 0.001].Of 24,183 treated lesions,the incidences of definite ST were 2.4% in the Overlap group and 0.9% in the Non-Overlap group [HR: 2.96(95%CI: 2.38-3.69),p < 0.001].Stent overlap was associated with a higher rate of target lesion revascularization(TLR)(9.4%)compared with stent non-overlap(6.4%,p < 0.001).Length of overlapping stent ?2.93 mm strongly correlated with definite ST.CONCLUSIONS The present study demonstrates that overlapping stents increase definite ST and revascularization in patients who underwent DES implantation during long-term follow-up.Additionally,the longer overlapping zone predicts the worse clinical outcomes in observation.