Background : Although stent fracture (SFx) is considered as one of the major causes of late cardiac events in drug eluting stent (DES) era, it remains unclear the long-term prognosis. We analyzed the late clinical and angiographic outcomes relative to treatment methods in patients with SFx after sirolimus-eluting stent (SES) implantation.
Methods : Between January 2004 and November 2008, a total of 64 patients with SFx after SES implantation were registered in SFx registry. They were treated according to physician’s decision and divided into percutaneous coronary intervention (PCI, n=18) and medical therapy group (MT, n=46). We compared the major adverse cardiac outcomes (MACE) including death, MI and target lesion revascularization between these groups.
Results : The mean duration from stent implantation to SFx presentation was 388±288 days. Clinical presentation of the SFx included: myocardial infarction 10.9%, unstable angina 3.1%, asymptomatic 86%. From a total of 85 SFxs lesions (mean 1.33 SFx/patient), 19 SFxs were treated by intervention (POBA 14, Stent 4, thrombus aspiration 1) and 66 SFxs were treated by medication only. At mean 2.7 year follow up, total MACE was 5.5% in the PCI group and 15.2% in the MT group (p=0.292). The mean duration from stent implantation to MACE was 949±398.66 days. There was no death, and the rate of MI and target lesion revascularization were 0% vs. 10.9% (p=0.145) and 5.5% vs. 13.0% (p=0.388), respectively.
Conclusions : In this observational analysis, untreated, silent SFx demonstrated high rate of adverse cardiac events, whereas treated SFx patients showed excellent clinical outcomes. So, we need a careful observation for the clinical consequences in asymptomatic SFx patients.
Key word : Angioplasty, DES, Fracture
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