Incidence and predictors of drug-eluting stent fractures in long coronary disease.
BACKGROUND
Stent fractures after drug-eluting stent (DES) implantation have not been evaluated sufficiently in patients with long coronary artery disease.


METHODS
This study comprised of 415 patients, who were enrolled in the Long-DES-II study and had a complete serial angiography both before and after procedure and also at follow-up. The lesions were > or =25 mm in length and were randomly treated with sirolimus-eluting stents (SES, 210 lesions) or paclitaxel-eluting stent (205 lesions).


RESULTS
DES fracture was identified in 7 lesions (1.7%): 1 minor, 3 moderate, and 3 severe fractures. Most of the fractures occurred in patients who received SES (85.7%) and in the right coronary artery (RCA) lesions (71.4%). Lesions with fracture had a smaller minimal lumen diameter before procedure than lesions without fracture (0.38+/-0.55 vs. 0.71+/-0.46 mm, p=0.043). However, acute gain (2.28+/-0.39 vs. 1.44+/-0.60 mm, p=0.001) and late loss (0.81+/-0.49 vs. 0.42+/-0.50 mm, p=0.033) in analysis segment were greater in lesions with fracture. By multivariate analysis, the independent predictor of fracture was the RCA lesion (Odds ratio, 7.81; 95% CI, 1.45 approximately 42.04; p=0.017). Although one patient had an intermediate angiographic narrowing at the fracture site, there was no adverse cardiac event related with fracture.


CONCLUSIONS
The incidence of stent fracture in long DES implantation was not common and was associated with SES implantation or RCA lesions. Fortunately, the clinical prognosis of DES fracture was somewhat benign.
Hallym University Sacred Heart Hospital, Anyang, Korea.
Hyun-Sook
HS
Kim
Young-Hak
YH
Kim
Seung-Whan
SW
Lee
Duk-Woo
DW
Park
Cheol Whan
CW
Lee
Myeong-Ki
MK
Hong
Seong-Wook
SW
Park
Jae-Ki
JK
Ko
Jae-Hyeong
JH
Park
Jae-Hwan
JH
Lee
Si Wan
SW
Choi
In-Whan
IW
Seong
Yoon Haeng
YH
Cho
Nae-Hee
NH
Lee
June Hong
JH
Kim
Kook-Jin
KJ
Chun
Seung-Jung
SJ
Park
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology* / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects* / Q000145:classification; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D012189:Retrospective Studies