title: Incidence and Clinical Impact of Stent Fracture After PROMUS Element Platinum Chromium Everolimus-Eluting Stent Implantation.
abstract: OBJECTIVE
  This study sought to assess the incidence and clinical impact of stent fracture (SF) after the PROMUS Element platinum-chromium everolimus-eluting stent (PtCr-EES).
  
  
  BACKGROUND
  SF remains an unresolved, clinically relevant issue, even in the newer-generation drug-eluting stent era.
  
  
  METHODS
  From March 2012 to August 2013, 816 patients with 1,094 lesions were treated only with PtCr-EES and 700 patients (85.7%) with 898 lesions undergoing follow-up angiography within 9 months after the index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by plain fluoroscopy, intravascular ultrasound, or optical coherence tomography during the follow-up. We assessed the rate of SF and the cumulative incidence of clinically driven target lesion revascularization and definite stent thrombosis within 9 months after the index procedure.
  
  
  RESULTS
  SF was observed in 16 of 898 lesions (1.7%) and 16 of 700 patients (2.2%). Lesions with in-stent restenosis at baseline (odds ratio [OR]: 14.2, 95% confidence intervals [CI]: 5.09 to 39.7; p < 0.001) or hinge motion (OR: 4.31, 95% CI: 1.12 to 16.5; p = 0.03), and total stent length (per 10-mm increase; OR: 1.32, 95% CI: 1.12 to 1.57; p = 0.001) were predictors of SF. Cumulative incidence of clinically driven target lesion revascularization within 9-months was numerically higher in the SF group than that in the non-SF group (18.7% vs. 2.3%). Cumulative incidence of definite stent thrombosis within 9 months after the index procedure was similar between the SF and non-SF groups (0.0% vs. 0.23%).
  
  
  CONCLUSIONS
  SF after PtCr-EES occurs in 1.7% of lesions and appears to be associated with clinically driven target lesion revascularization.
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan. Electronic address: kuramitsu@circulation.jp.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kuramitsu
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hiromasa
authors.affiliation: Department of Cardiology, Tenri Hospital, Nara, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Enomoto
authors.affiliation: Department of Biostatistics, School of Public Health, the University of Tokyo, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shinozaki
authors.affiliation: Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus School of Medicine, Okinawa, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Iwabuchi
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Mazaki
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Takenori
authors.initials: T
authors.lastname: Domei
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Kyohei
authors.initials: K
authors.lastname: Yamaji
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Soga
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hyodo
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Shirai
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002857:Chromium; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000453:epidemiology; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000453:epidemiology; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation*; D010984:Platinum; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D002317:Cardiovascular Agents; D002857:Chromium; D010984:Platinum; D000068338:Everolimus
keywords: drug-eluting stent fracture; platinum-chromium everolimus-eluting stent; target lesion revascularization