title: Impact of sirolimus-eluting stent fractures without early cardiac events on long-term clinical outcomes: a multislice computed tomography study.
abstract: OBJECTIVE
  This study sought to evaluate the impact of sirolimus-eluting stent (SES) fractures on long-term clinical outcomes using multislice computed tomography (MSCT).
  
  
  METHODS
  In this study, 528 patients undergoing 6- to 18-month follow-up 64-slice MSCT after SES implantation without early clinical events were followed clinically (the median follow-up interval was 4.6 years). A CT-detected stent fracture was defined as a complete gap with Hounsfield units (HU) <300 at the site of separation. The major adverse cardiac events (MACEs), including cardiac death, stent thrombosis, and target lesion revascularisation, were compared according to the presence of stent fracture.
  
  
  RESULTS
  Stent fractures were observed in 39 patients (7.4 %). MACEs were more common in patients with CT-detected stent fractures than in those without (46 % vs. 7 %, p < 0.01). Univariate Cox regression analysis indicated a significant relationship between MACE and stent fracture [hazard ratio (HR) 7.65; p < 0.01], age (HR 1.03; p = 0.04), stent length (HR 1.03; p < 0.01), diabetes mellitus (HR 1.77; p = 0.04), and chronic total occlusion (HR 2.54; p = 0.01). In the multivariate model, stent fracture (HR 5.36; p < 0.01) and age (HR 1.03; p = 0.04) remained significant predictors of MACE.
  
  
  CONCLUSIONS
  An SES fracture detected by MSCT without early clinical events was associated with long-term clinical adverse events.
  
  
  CONCLUSIONS
  • Long-term outcomes of sirolimus-eluting stent fracture have not been fully clarified. • MSCT could detect stent fracture with high accuracy. • Sirolimus-eluting stent fracture detected by MSCT was associated with long-term adverse events.
authors.affiliation: Toyohashi Heart Center, 21-1, Gobudori, Oyama-cho, Toyohashi, Japan, 4418530, tuyosiito@gmail.com.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ito
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Mariko
authors.initials: M
authors.lastname: Ehara
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Maoto
authors.initials: M
authors.lastname: Habara
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods; D064887:Observational Studies as Topic; D011475:Prosthesis Failure; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D020123:Sirolimus