Abstract 1930: Impact of Location of Geographical Miss on 1-year Outcomes after Sirolimus-eluting Stent Implantation: Insights from The STLLR Trial
Introduction: STLLR is the first prospective, multicenter (41 US hospitals), large (n=1557) study to assess clinical outcomes associated with sirolimus-eluting stent (SES) deployment techniques in real world practice and has shown the negative impact of geographical miss (GM) on 1-year revascularization and myocardial infarction rates.
Hypothesis: We assessed the hypothesis that the location of GM further influences the incidence of target lesion revascularization (TLR).
Methods: Quantitative coronary analysis and assessment of GM were performed by an independent core lab. GM was defined as longitudinal (injured or diseased segment not covered by SES) or axial (balloon/artery size ratio is <0.9[undersize] or >1.3[oversize]) by an independent core lab. Investigators and patients remained blind to the core lab GM assignments. All patients were followed for 1-year and events adjudicated independently.
Results: Overall, axial GM and longitudinal GM, occurred in 943 (66.6%), 500 (35.3%) and 676 (47.7%) patients, respectively. Undersize and oversize GM was found in 473 (94.6%) and 27 (5.4%) patients. Proximal, distal and multiple sites longitudinal GM were observed in 206 (30.5%), 229 (33.9%), 217 (32.1%) patients, respectively. One-year TLR rates were 4.1% in overall GM versus 1.7% in no-GM group (p=0.017). TLR rates were higher in all of the GM location subgroups compared to no-GM group, and highest in patients with proximal longitudinal GM (Figure⇓).
Conclusion: One-year TLR rates are higher in patients with GM than those without, irrespective of its location. Longitudinal GM at the proximal SES edge confers additional risk of 1-year TLR.