title: Comparison between Plain Old Balloon Angioplasty and Drug-Eluting Stent Implantation for the Treatment of Stent Fracture.
abstract: OBJECTIVE
  The aim of this study was to evaluate clinical outcomes after percutaneous coronary intervention (PCI) for stent fracture (SF).
  
  
  BACKGROUND
  SF has been reported as a predictor of in-stent restenosis (ISR) and stent thrombosis (ST).
  
  
  METHODS
  Between January 2009 and December 2012, consecutive SF cases treated with either drug-eluting stent (DES) or plain old balloon angioplasty (POBA) were retrospectively enrolled in this study. The study endpoints were all-cause death, cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), ST, re-stent fracture (re-SF), and major adverse cardiac events (MACE) defined as the composite of cardiac death, MI, and TLR.
  
  
  RESULTS
  Of 135 SF cases, 67 (49.6%) cases were treated with DES, whereas 68 (50.4%) cases with POBA. Median follow-up period was 1,401 (IQR: 967-1,771) days. The estimated MACE rate at 3 years was significantly lower in the DES group as compared with the POBA group largely driven by less TLR (25.7 vs. 55.8%, P < 0.001). Moreover, 1-year landmark analysis after PCI for SF revealed that MACE continued to occur even after 1 year irrespective of the treatment option (P = 0.47). On multivariable Cox regression analysis, POBA and large post-procedure angle (Δ) defined as the degree difference between the end systolic and diastolic angle were identified as independent predictors for TLR.
  
  
  CONCLUSIONS
  DES implantation for SF is associated with better clinical outcomes as compared to POBA alone, due to a lower need for TLR. Large post-procedural angle (Δ) appears to be an independent predictor of TLR.
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Mitomo
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hozawa
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kurita
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Tahara
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Hisaaki
authors.initials: H
authors.lastname: Ishiguro
authors.affiliation: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D019919:Prosthesis Implantation; D012189:Retrospective Studies