Background: Coronary artery disease (CAD) is becoming increasingly prevalent in aging populations. Long-diffuse CAD (ldCAD), characterized by lesions ≥30 mm, poses significant treatment challenges. This study aimed to evaluate the long-term prognostic differences between single long stents (SLS) and overlapping stents (OLS) in patients with ldCAD using second-generation and later drug-eluting stents (DES).

Methods and Results: A systematic review and meta-analysis of studies published between 2000 and October 2024 in PubMed, Embase, Web of Science, and the Cochrane Library was conducted. The primary outcome was major adverse cardiovascular events (MACE) over 1 year. The secondary outcomes were cardiac death, target lesion revascularization, target vessel revascularization (TVR), and fatal or non-fatal myocardial infarction (MI). The analysis included 5 studies with 2,756 patients, indicating no significant differences between SLS and OLS regarding MACE and TVR. However, MI incidence was significantly lower with SLS, whereas OLS showed a higher MI incidence, likely due to differences in lesion length rather than the strategy itself. Subanalyses indicated that SLS significantly reduced contrast volume compared with OLS, with a trend toward shorter lesions and stent lengths.

Conclusions: Stent overlap has minimal impact on prognosis with newer DES. Despite limitations from non-randomized data, further research is needed to optimize ldCAD treatment strategies and guide clinical practice.