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European Heart Journal 2001 22(17):1585-1593; doi:10.1053/euhj.2001.2752
Copyright © 2001 by the European Society of Cardiology.
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The influence of stent length on clinical and angiographic outcome in patients undergoing elective stenting for native coronary artery lesions; final results of the Magic 5L Study

D.P. Foleyf1, M. Pieper, W. Wijns, H. Suryapranata, G. Grollier, V. Legrand, I. de Scheerder, C. Hanet, J. Puel, H. Mudra, H.J.R.M. Bonnier, A. Colombo, M. Thomas, P. Probst, M.-C. Morice, J. Kleijne and P.W. Serruys on behalf of the MAGIC 5L investigators

revised April 10, 2001; accepted April 21, 2001

Abstract

Aims To prospectively evaluate the influence of stent length on 6 month clinical and angiographic outcome, in patients with native coronary lesions up to 45mm in length, undergoing elective Magic Wallstent implantation.

Methods and Results On the basis of pre-procedural angiography, 276 patients (aged 61·3±10·2 years; 78·6% male; 41·7% unstable angina) with a total of 302 lesions were prospectively assigned to one of five different length categories of Magic Wallstent. Angiography in multiple matched projections before and after implantation and at 6 months follow-up was analysed at the core laboratory. Primary end-points for the efficacy analysis were cumulative incidence of major adverse cardiac events and quantitative coronary angiography analysis 6 months after stent implantation. Magic Wallstent implantation was successful in 301 of 302 lesions and in 98·6% a residual stenosis <20% by online quantitative coronary angiography was achieved. At 30 days, 6·2% (1·8% subacute occlusion) of patients had experienced major adverse cardiac events, 27·5% at 6 months and 30·4% at 9 months. Angiographic restenosis occurred in 37%. Restenosis rates for the mini, extra-short, short, medium and long Wallstent groups were 25·9%, 25%, 22·6%, 36·2% and 67·5%, respectively. Multivariate analysis revealed stent length to be independently associated with greater angiographic restenosis and major adverse cardiac events.

Conclusions While shorter Magic Wallstents provided late outcomes comparable with short balloon-expandable stents, excessive restenosis with longer Wallstents should obviate their use in elective percutaneous intervention. Long coronary lesions provide a challenging substrate for emerging antirestenosis therapies, such as stent coatings and brachytherapy.

Key Words: Long lesions, Magic Wallstent, restenosis, quantitative coronary angiography, multicentre trial

f1 Correspondence: Dr David P. Foley, MB, MRCPI, PhD, FESC, Interventional Cardiology, Thoraxcentre Bd 414, Academic Hospital Rotterdam, Dr molewaterplein 40, 3015 GD Rotterdam, Netherlands.

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