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Do drug elution components increase the risk of fracture of sirolimus-eluting stents?

Kawai, Tomokoa; Umeda, Hisashib; Ota, Masayaa; Hattori, Kousukea; Ishikawa, Makotoa; Okumura, Masanoria; Kan, Shinoa; Nakano, Tadashia; Naruse, Hiroyukia; Matsui, Shigerua; Ishii, Junichia; Hishida, Hitoshia; Ozaki, Yukioa

doi: 10.1097/MCA.0b013e32833aa6a1
Therapy and Prevention

Objectives: Stent fracture (SF) of sirolimus-eluting stents (SES) has emerged recently in the literature and shown to be associated with an increased risk of restenosis; however, little is known regarding SF after bare-metal stent implantation. We sought to assess whether the use of SES was associated with an increased risk of SF compared with its bare-metal platform, the Bx-velocity stent (BX-BMS).

Methods: A total of 478 lesions in 416 patients undergoing SES implantation and subsequent angiography 6−9 months after the index procedure were compared with 152 lesions in 142 consecutive patients treated with BX-BMS. Stented lesions with total stent-length greater than 40 mm were excluded.

Results: There were no significant differences in overall baseline clinical and anatomic features between the SES and BX-BMS groups, or in SF frequencies at 6–9 month follow-up (4.4% for SES and 1.3% for BX-BMS, P=0.078). In-stent restenosis was observed more often in SF lesions versus non-SF lesions (34.8 vs. 7.7%, P<0.001) in association with a higher 3-year adverse events rate (27.3 vs. 13.6%, P=0.076). The risk of SF at 6–9 months was independently associated with total stent length [odds ratio (OR), 2.13; 95% confidence interval (CI), 1.18–3.83; P=0.012], angulated lesions (OR, 4.25; 95% CI, 1.80–10.00; P=0.001), and right coronary artery lesions (OR, 3.55; 95% CI, 1.46–8.62; P=0.005) but not with SES use.

Conclusion: Stent implantation in right coronary artery lesions, tortuous lesions, and/or longer lesions covered with longer stents, and not SES versus BX-BMS use, may be associated with increased likelihood of SF.

aDepartment of Cardiology, Fujita Health University Hospital, Toyoake

bDivision of Cardiology, Toyota Memorial Hospital, Toyota, Japan

Correspondence to Dr Yukio Ozaki, MD, Department of Cardiology, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Japan

Tel: +81 90 1560 9030; fax: +81 10 52 917 3169;

e-mail: ozakiyuk@fujita-hu.ac.jp

Received 18 January 2010 Revised 21 March 2010 Accepted 2 April 2010

© 2010 Lippincott Williams & Wilkins, Inc.