Abstract 5954: Does Sirolimus-Eluting Stent Implantation Lead to an Increased Risk of Stent Fracture?

Abstract

Stent fracture (SF) of sirolimus-eluting stents (SES) has emerged recently in literature and shown to be associated with an increased risk of restenosis. We sought to assess whether the use of SES increases the frequency of SF compared with bare-metal stents (BMS). A consecutive series of 499 lesions of 434 patients undergoing SES implantation (total stent length: 10 to 40 mm) followed by coronary angiography at 6 to 9 months were compared with 137 consecutive patients (147 lesions) treated with BMS (total stent length: 10 to 40 mm) which consists of stent platform of SES. SF was defined as single or multiple stent strut fracture as well as complete separation of stent segments. There were no significant differences in total stent length and the angulation of the lesion between the 2 groups. At follow up, SF occurred in 21 lesions (4.2%) in the SES group and 2 lesions (1.4%) in the BMS group (P=0.129). In-stent restenosis rates were 34.8% (SES; 33.3%, BMS; 50.0%) in lesions with SF and 7.7% (SES; 3.8%, BMS; 20.7%) in lesions without SF (P<0.001). As a result, cumulative rate of major adverse cardiac events at 1 year (death, myocardial infarction, or target lesion revascularization) was higher in patients with SF than in patients without SF (27.3% vs. 12.0%, P=0.035, SES; 25.0% vs. 8.2%, P=0.035, BMS; 50.0% vs. 23.7%, P=0.425). Figure summarizes multivariable predictors of SF. In this model, SES use was not associated with a significantly increased risk of SF at 6 to 9 months. The implantation of stents in tortuous lesion and/or longer lesions covered with longer stents rather than the use of SES may increase the likelihood of SF in this population subset.