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.

METHODS AND 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: Masanobu Ohya, Kazushige Kadota, Takeshi Tada, Seiji Habara, Takenobu Shimada, Hidewo Amano, Yu Izawa, Yusuke Hyodo, Koshi Miyake, Suguru Otsuru, Daiji Hasegawa, Hiroyuki Tanaka, Takeshi Maruo, Harumi Katoh, Yasushi Fuku, Tsuyoshi Goto, Kazuaki Mitsudo
• Journal: Circulation. Cardiovascular interventions (Circ Cardiovasc Interv) Vol. 8 Issue 8 Pg. e002664 (Aug 2015) ISSN: 1941-7632 [Electronic] United States
• PMID: 26227346 (Publication Type: Journal Article)
• Copyright: © 2015 American Heart Association, Inc.

Chemical References

• Immunosuppressive Agents
• Sirolimus

Topics

• Aged
• Angioplasty, Balloon, Coronary (instrumentation)
• Coronary Angiography
• Coronary Artery Disease (therapy)
• Coronary Restenosis
• Coronary Thrombosis (etiology, mortality)
• Drug-Eluting Stents
• Female
• Humans
• Immunosuppressive Agents (administration & dosage)
• Male
• Middle Aged
• Myocardial Infarction (etiology, mortality)
• Prosthesis Failure
• Sirolimus (administration & dosage)
• Treatment Outcome