西罗莫司洗脱支架中冠状动脉支架断裂与支架内再狭窄的显著相关性。

Significant association of coronary stent fracture with in-stent restenosis in sirolimus-eluting stents.

作者信息

Kim Jung-Sun, Lee Seung-Yul, Lee Jung Myung, Yoon Young Won, Ahn Chul-Min, Kim Myung-Hyun, Min Pil-Ki, Ko Young-Guk, Hong Bum-Kee, Choi Donghoon, Kwon Hyuck Moon, Jang Yangsoo, Shim Won-Heum

机构信息

Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

Coron Artery Dis. 2009 Jan;20(1):59-63. doi: 10.1097/MCA.0b013e32830fd101.

DOI:10.1097/MCA.0b013e32830fd101

PMID:19008765

Abstract

BACKGROUND

Several reports have suggested that stent fractures in sirolimus-eluting stents (SESs) might be related to in-stent restenosis (ISR). However, the role of stent strut fracture in ISR has not been clearly elucidated. Therefore, we investigated the association of the SES fracture and ISR.

METHODS

From 2003 to 2006, SES implantations with follow-up coronary angiography (CAG) for 628 lesions in 557 patients were analyzed. We reviewed clinical and procedural factors that might affect SES fracture and ISR. The median time interval from stent implantation to follow-up CAG was 9 months (range: 2-30 months).

RESULTS

ISR occurred in 38 patients (5.7%), and 21 stent fractures (3.3%) were identified by follow-up CAG. Fourteen cases occurred in the left anterior descending artery, and seven occurred in the right coronary artery. The binary ISR rate in the stent fracture group was higher compared with that of the nonfracture group (38.1% vs. 4.6%, P<0.001). Predictors of ISR as estimated by multivariate analysis were a stent diameter less than 2.75 mm [odds ratio (OR)=2.76, P=0.012], a stent length over 28 mm (OR=3.30, P=0.024), and stent fracture (OR=11.03, P<0.001) after controlling for the angiographic and clinical risk factors of ISR.

CONCLUSION

Stent fracture was an independent predictor of ISR and may be one of the crucial mechanisms of ISR after implantation of an SES.

摘要

背景

多项报告表明，西罗莫司洗脱支架（SES）的支架断裂可能与支架内再狭窄（ISR）有关。然而，支架支柱断裂在ISR中的作用尚未明确阐明。因此，我们研究了SES断裂与ISR之间的关联。

方法

分析了2003年至2006年期间557例患者628处病变的SES植入及后续冠状动脉造影（CAG）情况。我们回顾了可能影响SES断裂和ISR的临床及手术因素。从支架植入到后续CAG的中位时间间隔为9个月（范围：2 - 30个月）。

结果

38例患者（5.7%）发生ISR，通过后续CAG发现21处支架断裂（3.3%）。14例发生在左前降支，7例发生在右冠状动脉。支架断裂组的二元ISR发生率高于未断裂组（38.1%对4.6%，P<0.001）。在控制了ISR的血管造影和临床风险因素后，多变量分析估计的ISR预测因素为支架直径小于2.75 mm[比值比（OR）=2.76，P = 0.012]、支架长度超过28 mm（OR = 3.30，P = 0.024）以及支架断裂（OR = 11.03，P<0.001）。