OBJECTIVETo assess the acute and long-term angiographic outcome of placement of long stents with different diameters for treatment of long diffuse coronary lesions.

METHODSAcute and long-term (3-and 6-month follow-up) quantitative coronary angiographic (QCA) data were obtained from 293 consecutive patients (65.9-/+8.2 years old, including 232 male patients) with long stent placement. The patients were divided into 4 groups according to the diameter of the stent implanted: group A (diameter> or =4.0 mm, n=68), Group B (3.5 mm< or =diameter < 4.0 mm, n=113), Group C (3.0 mm < or = diameter <3.5 mm, n=90) and Group D (2.5 mm< or =diameter<3.0 mm, n=22). The baseline demographic, angiographic and procedural details were similar in these 4 groups.

RESULTSThe procedural success rate was 100%. In groups A, B, C and D, the mean lesion length (LL) before the procedure was 20.92-/+10.96 mm, 20.01-/+10.07 mm, 20.13-/+11.08 mm and 23.08-/+6.51 mm (P=NS), with average total stent length for each lesion of 28.40-/+5.10 mm, 29.85-/+8.47 mm, 30.20-/+7.13 mm and 26.42-/+4.85 mm, respectively (P=NS). At 3- and 6-month angiographic follow-up, the angiographic binary lesion restenosis rate was significantly higher in the smaller-stent group (8.8%, 15.0%, 33.3% and 72.7% at 3-month, and 17.6%, 25.7%, 41.1% and 72.7% at 6-month follow-up, respectively, P<0.001 between each 2 groups). Group A had reduced target vessel revascularization rate compared with groups B, C and D (19.1% vs 30.1%, 54.4% and 72.7% at 3-month; 30.9% vs 44.2%, 66.7% and 81.8% at 6-month follow-up, P<0.001) at follow-up. These differences appeared to result from a lesser acute gain and a lesser net gain in smaller-stent group.

CONCLUSIONLong stents of larger diameters result in a significant reduction of angiographic restenosis rate and target vessel revascularization rate for the management of long diffuse lesion.