Long-term clinical and angiographic outcomes of patients with sirolimus-eluting stent fracture

Background: There is limited data on the long-term outcomes of patients with sirolimus-eluting stent (SES) fracture. Methods: After performing index percutaneous coronary intervention (PCI) with SES from Dec. 2003 to Dec. 2007, the patients with stent fracture (SF) detected by angiography at follow-up or adverse events were enrolled. SF was angiographically defined as complete or partial separation of the stent and this had been contiguous after stenting. The patients were divided into two groups as SF without in-stent restenosis (ISR) (Group 1, n = 55) and SF with ISR (Group 2, n = 44) and the patients were clinically and angiographically followed up after the detection of SF. The major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis (ST) were determined. Results: At SF detection, most patients were asymptomatic (92.7% in Group 1 vs. 43.2% in Group 2, p = 0.001). Acute coronary syndrome developed in 18.2% of Group 2, but it developed in only 1.8% of the patients of Group 1. Clinical follow-up was done in all patients for 675 ± 375 days from SF detection. From the detection of SF, MACEs were noted in 32.3% of the patients (10.9% in Group 1 vs. 59.1% in Group 2, p = 0.001), mostly from TVR (9.1% in Group 1 vs. 54.5% in Group 2, p = 0.001). Conclusion: The long-term follow-up results of SF after SES implantation show an increased risk of adverse cardiac events, and especially for the patients with ISR.