title: Incidence and Clinical Outcomes of Stent Fractures on the Basis of 6,555 Patients and 16,482 Drug-Eluting Stents From 4 Centers.
abstract: The present study aimed to analyze the incidence of SF and its correlation with clinical events after DES implantation and the outcome of re-intervention for symptomatic in-stent restenosis (ISR) induced by stent fracture (SF).
  
  
  
  SF is associated with a high rate of clinical events after the implantation of drug-eluting stents (DES). However, the chronological rate of SF and the effect of SF on clinical outcomes from a large patient population remain underreported.
  
  
  
  A total of 6,555 patients with 16482 DES in 10751 diseased vessels and surveillance angiography between November 2003 and January 2014 were prospectively studied. The primary endpoints included the incidence of SF, in-stent restenosis (ISR), target lesion revascularization (TLR), and definite stent thrombosis (ST) at the end of follow-up before and after propensity score matching. Clinical outcomes after TLR were also followed up.
  
  
  
  The SF rate was detected in 803 (12.3%) patients, 3,630 (22.0%) stents, and 1,852 (17.2%) diseased vessels. SF increased over time. SF was associated with higher unadjusted rates of ISR (42.1%), TLR (24.8%, n = 379), and definite ST (4.6%) compared with stents without fracture (10.7%, 6.6%, and 1.03%, all p < 0.001), and the differences remained significant after propensity score matching (all p < 0.05). There was no significant difference in any-cause or cardiac mortality between patients with and without SF. After 1,523 days of follow-up since the first surveillance angiography, repeat ISR was detected in 90 of 379 (23.8%) stents after reintervention, and 6 (7.5%) stents required repeat TLR.
  
  
  
  SF is more frequently observed after DES implantation. TLR was required in almost one-fourth of fractured stents. Increased events in the SF group did not translate into a difference in mortality compared with the non-SF group. Reintervention was associated with acceptable clinical results.
authors.affiliation: Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Kan
authors.affiliation: Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Ge
authors.affiliation: Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Zhang
authors.affiliation: Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Zhi-Zhong
authors.initials: ZZ
authors.lastname: Liu
authors.affiliation: Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Nai-Liang
authors.initials: NL
authors.lastname: Tian
authors.affiliation: Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.affiliation: Division of Cardiology, Jintan People Hospital, Jintan, China.
authors.forename: Sui-Ji
authors.initials: SJ
authors.lastname: Li
authors.affiliation: Division of Cardiology, Zhangjiagang People Hospital, Jiangsu, China.
authors.forename: Xue-Song
authors.initials: XS
authors.lastname: Qian
authors.affiliation: Division of Cardiology, Yixin People Hospital, Wuxi, China.
authors.forename: Song
authors.initials: S
authors.lastname: Yang
authors.affiliation: Division of Arts and Science, Emory College of Arts and Science, Emory University, Atlanta, Georgia.
authors.forename: Meng-Xuan
authors.initials: MX
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Tanveer
authors.initials: T
authors.lastname: Rab
authors.affiliation: Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. Electronic address: chmengx@126.com.
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D015995:Prevalence; D011475:Prosthesis Failure; D012042:Registries; D019233:Retreatment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: drug-eluting stent(s); restenosis; stent fracture; stent thrombosis; target lesion revascularization