title: Incidence and clinical impact of stent fracture after everolimus-eluting stent implantation.
abstract: BACKGROUND
  Stent fracture (SF) after drug-eluting stent implantation has recently become an important concern because of its potential association with in-stent restenosis and stent thrombosis. However, the incidence and clinical impact of SF after everolimus-eluting stent implantation remain unclear.
  
  
  RESULTS
  A total of 1035 patients with 1339 lesions undergoing everolimus-eluting stent implantation and follow-up angiography 6 to 9 months after index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by plain fluoroscopy or intravascular ultrasound during follow-up. We assessed the rates of SF and major adverse cardiac events, defined as cardiac death, myocardial infarction, stent thrombosis, and clinically driven target lesion revascularization within 9 months. SF was observed in 39 of 1339 lesions (2.9%) and in 39 of 1035 patients (3.8%). Ostial stent location and lesions with hinge motion, tortuosity, or calcification were independent predictors of SF. The rate of myocardial infarction and target lesion revascularization were significantly higher in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018 and 25.6% versus 2.0%; P<0.001, respectively). Stent thrombosis was more frequently observed in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018). Major adverse cardiac events within 9 months were significantly higher in the SF group than in the non-SF group (25.6% versus 2.3%; P<0.001).
  
  
  CONCLUSIONS
  SF after everolimus-eluting stent implantation occurs in 2.9% of lesions and is associated with higher rate of major adverse cardiac events, driven by higher target lesion revascularization and stent thrombosis.
authors.affiliation: Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kuramitsu
authors.forename: Masashi
authors.initials: M
authors.lastname: Iwabuchi
authors.forename: Takuya
authors.initials: T
authors.lastname: Haraguchi
authors.forename: Takenori
authors.initials: T
authors.lastname: Domei
authors.forename: Ayumu
authors.initials: A
authors.lastname: Nagae
authors.forename: Makoto
authors.initials: M
authors.lastname: Hyodo
authors.forename: Kyohei
authors.initials: K
authors.lastname: Yamaji
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Soga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Arita
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Kondo
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.forename: Koyu
authors.initials: K
authors.lastname: Sakai
authors.forename: Masahiko
authors.initials: M
authors.lastname: Goya
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Takabatake
authors.forename: Shinjo
authors.initials: S
authors.lastname: Sonoda
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Yokoi
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Toyota
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nosaka
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000175:diagnosis / Q000401:mortality / Q000628:therapy
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus