Abstract 2563: Impact of Type of Longitudinal Geographical Miss on Clinical Outcome after Sirolimus-eluing Stent Implantation: Insights from The STLLR Trial
Introduction: The STLLR trial is the first prospective, multicenter (41 US hospitals), large (n=1,557) study to assess clinical outcomes associated with sirolimus-eluting stent (SES) deployment techniques in real world practice. Geographical miss (GM) occurs frequently during SES implantation and is associated with an increased risk of target vessel revascularization (TVR) at 1-year. Furthermore, rate of TVR was significantly higher in patients with longitudinal GM (LGM). However, it is unclear what type of LGM impacts on the incidence of revascularization. The aim of this study is to evaluate the influence of type and location of LGM on clinical outcome.
Methods: Quantitative coronary analysis and assessment of LGM, defined as injured or diseased segment uncovered by SES, was performed and adjudicated by an independent core lab. Investigators and patients remained blind to core lab LGM assignments. All events were followed for 12 months and adjudicated independently by a clinical event committee.
Results: GM was assessed in 1,416 patients. Overall, LGM (proximal or distal edge), was observed in 658 (46.4%). Diseased, injured, and both was documented in 208 (31.6%), 310 (47.1%) and 140 (21.3%) patients, respectively. Diseased type showed the highest incidence of TVR and target lesion revascularization (TLR). In the diseased type, proximal, distal and both side LGM was observed in 100 (48.1%), 91 (43.8%), 17 (8.2%) patients, respectively. Notably, proximal diseased type showed the highest rate of TVR and TLR.
Conclusion: Overall, LGM is a major contributor to TVR and TLR. In particular, proximal diseased type of LGM represented the highest impact on TVR and TLR.