title: Significant association of coronary stent fracture with in-stent restenosis in sirolimus-eluting stents.
abstract: 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.
authors.affiliation: Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Seung-Yul
authors.initials: SY
authors.lastname: Lee
authors.forename: Jung Myung
authors.initials: JM
authors.lastname: Lee
authors.forename: Young Won
authors.initials: YW
authors.lastname: Yoon
authors.forename: Chul-Min
authors.initials: CM
authors.lastname: Ahn
authors.forename: Myung-Hyun
authors.initials: MH
authors.lastname: Kim
authors.forename: Pil-Ki
authors.initials: PK
authors.lastname: Min
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Bum-Kee
authors.initials: BK
authors.lastname: Hong
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Hyuck Moon
authors.initials: HM
authors.lastname: Kwon
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Won-Heum
authors.initials: WH
authors.lastname: Shim
mesh_terms: 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
chemical_list: D002317:Cardiovascular Agents; D020123:Sirolimus