title: Stent Fracture After Sirolimus-Eluting Stent Implantation: 8-Year Clinical Outcomes.
abstract: BACKGROUND
  Stent fracture (SF) after sirolimus-eluting stent implantation is reported to be associated with target lesion revascularization (TLR) and stent thrombosis. We aimed to assess the clinical impact of SF at 8 years.
  
  
  RESULTS
  Between 2002 and 2005, 972 patients (1795 lesions) underwent sirolimus-eluting stent implantation and follow-up angiography within 1 year after index procedure. SF, defined as the complete separation of stent segments or stent struts at follow-up angiography, was observed in 105 lesions (5.8%). The study sample comprised 954 patients (1630 lesions), excluding 147 lesions undergoing TLR and 18 patients (18 lesions) who died or in whom stent thrombosis developed within 1 year after sirolimus-eluting stent implantation. The median follow-up duration was 9.1 years (the first and third quarters, 8.7 and 9.4 years). The primary end point was defined as any TLR. The 8-year cumulative rates of adverse events were estimated by Kaplan-Meier methods with P values from log-rank tests. Between patients with and without SF, there were no significant differences in the cumulative rates of all-cause death (23.5% versus 27.6%, P=0.35) and cardiac death (4.7% versus 9.1%, P=0.14), whereas patients with SF had significantly higher cumulative rates in myocardial infarction (10.1% versus 3.3%, P=0.001), very late stent thrombosis (6.8% versus 0.7%, P<0.001), any TLR (38.1% versus 10.8%, P<0.001), and clinically driven TLR (26.2% versus 6.6%, P<0.001).
  
  
  CONCLUSIONS
  SF after sirolimus-eluting stent implantation was consistently associated with higher rates of adverse cardiac events during the 8-year follow-up.
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Ohya
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tada
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Habara
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Takenobu
authors.initials: T
authors.lastname: Shimada
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Hidewo
authors.initials: H
authors.lastname: Amano
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Izawa
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hyodo
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Koshi
authors.initials: K
authors.lastname: Miyake
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Otsuru
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Daiji
authors.initials: D
authors.lastname: Hasegawa
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Maruo
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Harumi
authors.initials: H
authors.lastname: Katoh
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fuku
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Goto
authors.affiliation: From the Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan. k-kadota@lapis.plala.or.jp.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis; D003328:Coronary Thrombosis / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011475:Prosthesis Failure; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus
keywords: angiography; drug-eluting stent; myocardial infarction; percutaneous coronary intervention; stent fracture