Incidence and clinical impact of fracture of drug-eluting stents widely used in current clinical practice: comparison with initial platform of sirolimus-eluting stent.
BACKGROUND
Almost all data on drug-eluting stents (DES) fracture have been derived from initial platform of first-generation DES such as Cypher Bx® (CBX) and Taxus Express®. However, incidence and clinical impact of fracture of newer DES platforms (including Cypher Select®, Taxus® Liberté™, Endeavor®, and Xience™ V) that have been used widely in current clinical practice have not yet been studied.


RESULTS
We analyzed data of 1518 lesions treated with the newer DES platforms in patients who underwent follow-up coronary angiography and compared the results with those of 622 lesions treated with the CBX. The group of newer DES platforms showed significantly lower incidence of stent fracture (SF) than the CBX group (1.25% vs. 5.8%, p<0.001). Binary restenosis (42.1% vs. 6.6%, p<0.001) and target lesion revascularization (TLR) (47.3% vs. 6.2%, p<0.001) related to SF in the newer DES platforms' group were significantly higher than those not related to SF. Notably, SF-related binary restenosis (42.1% vs. 36.1%, p=0.52) and TLR (47.3% vs. 41.6%, p=0.2) were similar between the newer DES platforms' group and the CBX group. On multivariable logistic regression analysis, lesion angulation>45° (odds ratio [OR]: 7.6; 95% confidence interval [CI]: 2.2-26.31), RCA stenting (OR: 5.14; 95% CI: 1.62-16.3) and total stent length (OR: 1.18; 95% CI: 1.03-1.33) were identified as independent predictors for fracture of the newer DES platforms, while closed-cell design stent (Cypher Select®) was not.


CONCLUSIONS
Although implantation of the newer DES platforms might reduce the occurrence of SF compared with the CBX, SF-related binary restenosis and TLR remain similarly high. And to predict SF in the newer DES platforms' era, lesion characteristics on index procedure are more important than implanted stent design.
The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea.
Mahn-Won
MW
Park
Kiyuk
K
Chang
Sung Ho
SH
Her
Jong-Min
JM
Lee
Yun-Seok
YS
Choi
Dong-Bin
DB
Kim
Pum Joon
PJ
Kim
Jung Sun
JS
Cho
Min Seok
MS
Choi
Ju Yeol
JY
Baek
Chul-Su
CS
Park
Seong Gyu
SG
Yoon
Wook Sung
WS
Chung
Ki Bae
KB
Seung
D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy; D023903:Coronary Restenosis / Q000209:etiology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D020123:Sirolimus / Q000008:administration & dosage*
D020123:Sirolimus