Very long-term outcome of coronary covered stents: a report from the SCAAR registry

Aims: Covered stents are mostly used for coronary perforations with a high risk of early adverse events; however, their long-term outcome is unknown. The aim of this study was to elucidate the short-and long-term outcome of patients treated with covered stents compared to all other stented patients. Methods and results: The Swedish national registries from 2005-2017 disclosed 265 patients who had received 366 covered stents. Their outcomes were compared to all other stented patients (197,948) who had received 320,784 stents. Compared to regular stents, covered stents showed significant differences (p<0.001) in the short and long term in relation to in-stent restenosis (ISR), target lesion revascularisation (TLR), re-infarction (MI), re-PCI and mortality, the rates of which were all higher. The higher mortality was concentrated within the first month, as a landmark analysis at that time point, adjusted for age and procedural indication, demonstrated no future difference in mortality (HR 1.02 [0.78-1.33], p=0.877). Stent thrombosis (ST) within one year was reported to be higher in covered stents than in other stents. However, no ST was reported in equine pericardial covered stents. Conclusions: This observational study including the entire Swedish population shows that patients receiving covered stents have a significantly higher risk of all adverse events. Reassuringly, in the long term, mortality appears to be similar to that in other stented patients.