Abstract 1926: The Incidence, Predictors, and Outcome of Delayed Stent Fracture After Successful Implantation of Sirolimus-Eluting Stents

Abstract

Background: Recently, stent fracture (SF) of sirolimus-eluting stents (SES) has been shown to be associated with an increased risk of restenosis after SES implantation. We sought to assess the incidence, predictors, and clinical outcome of SF after implantation of SES. Methods: A consecutive series of 430 lesions of 382 patients treated with SES followed by coronary angiography at 6 to 9 months were analyzed. SF was defined as complete transverse liner separation or single or multiple stent strut fracture. Results: At follow up, SF occurred in 33 of 430 lesions (7.7%), and 32 of 382 patients (8.4%). In 23 of 33 lesions (69.7%), SF was found in a single point, whereas SF occurred in 2 or more points per lesion in 10 lesions (30.3%). Minimal lumen diameter was significantly smaller in patients with SF (2.11±0.64 mm vs. 2.52±0.60 mm, P <0.001), presumably due to greater late lumen loss (0.36±0.57 mm vs. 0.08±0.50 mm, P =0.005). Consequently, in-stent restenosis in lesions with SF was observed more frequently than non-SF lesions (15.2% vs. 4.0%, P =0.004). At 450 days, however, the cumulative rate of major adverse cardiac events (death, myocardial infarction, or target lesion revascularization) was similar in patients with and without SF (9.1% vs. 7.1%, P =0.722). Multivariable predictors of SF were shown in Figure . Conclusions: The occurrence of SF 6 to 9 months after implantation of SES in consecutive “real-world” patients was relatively common, which did not lead to an increased risk of adverse cardiac events at 450 days. Total stent length, the reduction in the lesion angle by stenting, and lesions located on the right coronary artery were identified as predictors of SF after implantation of SES.