Significant association of coronary stent fracture with in-stent restenosis in sirolimus-eluting stents.
BACKGROUND
Several reports have suggested that stent fractures in sirolimus-eluting stents (SESs) might be related to in-stent restenosis (ISR). However, the role of stent strut fracture in ISR has not been clearly elucidated. Therefore, we investigated the association of the SES fracture and ISR.


METHODS
From 2003 to 2006, SES implantations with follow-up coronary angiography (CAG) for 628 lesions in 557 patients were analyzed. We reviewed clinical and procedural factors that might affect SES fracture and ISR. The median time interval from stent implantation to follow-up CAG was 9 months (range: 2-30 months).


RESULTS
ISR occurred in 38 patients (5.7%), and 21 stent fractures (3.3%) were identified by follow-up CAG. Fourteen cases occurred in the left anterior descending artery, and seven occurred in the right coronary artery. The binary ISR rate in the stent fracture group was higher compared with that of the nonfracture group (38.1% vs. 4.6%, P<0.001). Predictors of ISR as estimated by multivariate analysis were a stent diameter less than 2.75 mm [odds ratio (OR)=2.76, P=0.012], a stent length over 28 mm (OR=3.30, P=0.024), and stent fracture (OR=11.03, P<0.001) after controlling for the angiographic and clinical risk factors of ISR.


CONCLUSIONS
Stent fracture was an independent predictor of ISR and may be one of the crucial mechanisms of ISR after implantation of an SES.
Kim
Jung-Sun
JS
Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Lee
Seung-Yul
SY
Lee
Jung Myung
JM
Yoon
Young Won
YW
Ahn
Chul-Min
CM
Kim
Myung-Hyun
MH
Min
Pil-Ki
PK
Ko
Young-Guk
YG
Hong
Bum-Kee
BK
Choi
Donghoon
D
Kwon
Hyuck Moon
HM
Jang
Yangsoo
Y
Shim
Won-Heum
WH
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D023921:Coronary Stenosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D020123:Sirolimus