J Korean Med Sci.  2011 Jan;26(1):53-58. 10.3346/jkms.2011.26.1.53.

Clinical Characteristics of Coronary Drug-Eluting Stent Fracture: Insights from a Two-Center DES Registry

• Park KW
• Park JJ
• Chae IH
• Seo JB
• Yang HM
• Lee HY
• Kang HJ
• Cho YS
• Yeon TJ
• Chung WY
• Koo BK
• Choi DJ
• Oh BH
• Park YB
• Kim HS

• KMID: 1777976
• DOI: http://doi.org/10.3346/jkms.2011.26.1.53

Abstract

Stent fracture (SF) has been implicated as a risk factor for in-stent restenosis, but its incidence and clinical characteristics are not well established. Therefore we investigated the conditions associated with stent fracture and its clinical presentation and outcome. Between 2004 and 2007, consecutive cases of SF were collected from the Seoul National University Hospital. Clinical characteristics and outcome of patients with fractured stents were compared with a ten-fold cohort of age and gender matched controls (n = 236). A total of 4,845 patients received percutaneous coronary intervention and 3,315 patients (68.4%) underwent angiographic follow-up. Twenty-eight fractured stents were observed in 24 patients. The incidence of SF was 0.89% for sirolimus-eluting stents (SES) and 0.09% for paclitaxel-eluting stents. Chronic kidney disease, stent implantation in the right coronary artery (RCA), and SES use were independent predictors of drug-eluting stent fracture by multivariate analysis. SF was significantly associated with binary restenosis (11.4% vs 41.7%, P < 0.001) and increased risk of target lesion revascularization (8.1% vs 33.3%, P = 0.001). Patients with SF but without significant restenosis showed excellent outcome despite only medical treatment. In conclusion, SF is associated with increased rates of restenosis and repeat revascularization. Significant risk factors include chronic kidney disease, RCA intervention, and SES use.

Keyword

DES Fracture; Risk Factors; In-stent Restenosis; Target Vessel Revascularization; Clinical Outcome

MeSH Terms

Age Factors
Aged
Cardiovascular Agents/administration & dosage
Cohort Studies
Coronary Angiography
Coronary Restenosis/diagnosis/*epidemiology/prevention & control
Coronary Stenosis/radiography/therapy
*Drug-Eluting Stents
Female
Humans
Male
Middle Aged
Paclitaxel/administration & dosage
*Prosthesis Failure
Registries
Risk Factors
Sex Factors
Sirolimus/administration & dosage

Figure

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  Fig. 1 Clinical outcome of patients regarding binary restenosis (BS) and target lesion revascularization (TLR) rate. Patients with fractured stents (SF) have higher binary restenosis and target lesion revascularization rate compared with those without fracture.

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  Fig. 2 Clinical presentation at 6 month follow up CAG or stent fracture diagnosis. Patients with angina score CCS 0 or 1 were less common among those with stent fracture (SF) and binary restenosis (BS) compared with those without stent fracture or stent fracture without binary restenosis. CCS, Canadian Cardiology Society functional classification; n.s., not significant.

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