Chhatriwalla Adnan K, Cam Akin, Unzek Samuel, Bhatt Deepak L, Raymond Russell E, Lincoff A Michael, Whitlow Patrick L, Ellis Stephen G, Tuzcu E Murat, Kapadia Samir R
Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Cardiovasc Revasc Med. 2009 Jul-Sep;10(3):166-71. doi: 10.1016/j.carrev.2009.02.003.
Coronary stent fracture is an underrecognized entity but has been reported more frequently in the drug-eluting stent (DES) era. Nevertheless, the clinical implications of coronary stent fracture remain unclear.
A literature search for reports of DES fracture was conducted via MEDLINE, and the US Food and Drug Administration Manufacturer and User facility Device Experience (MAUDE) database was accessed via the internet and interrogated for reports of stent fracture between January 1, 2003, and April 30, 2008. Each report was reviewed, and clinical information was extracted for analysis.
The MEDLINE search identified 202 cases of coronary DES fracture, with 95% of cases involving Cypher sirolimus-eluting stents. Clinical information regarding patient presentation was available in 96 cases. Patients presented with ST-elevation myocardial infarction (STEMI) or stent thrombosis in six cases (6%) and with unstable angina or non-STEMI (NSTEMI) in 40 cases (42%). The MAUDE database search identified 337 stent fracture reports, with 97% of cases involving Cypher stents. Clinical information regarding patient presentation was available 193 cases. Patients presented with STEMI or stent thrombosis in 24 cases (12%) and with unstable angina or NSTEMI in 36 cases (19%).
Most reports of drug-eluting stent fracture involve Cypher stents. DES fracture can be associated with stent thrombosis, myocardial infarction and angina. However, whether the incidence of such events reported in the literature and in the MAUDE database is representative of all patients experiencing stent fracture remains unclear.
冠状动脉支架断裂是一个未被充分认识的问题，但在药物洗脱支架（DES）时代报告更为频繁。然而，冠状动脉支架断裂的临床意义仍不明确。
通过MEDLINE对DES断裂报告进行文献检索，并通过互联网访问美国食品药品监督管理局制造商和用户设施设备经验（MAUDE）数据库，查询2003年1月1日至2008年4月30日期间的支架断裂报告。对每份报告进行审查，并提取临床信息进行分析。
MEDLINE检索识别出202例冠状动脉DES断裂病例，其中95%的病例涉及西罗莫司洗脱支架（Cypher）。96例病例有关于患者表现的临床信息。6例（6%）患者表现为ST段抬高型心肌梗死（STEMI）或支架血栓形成，40例（42%）患者表现为不稳定型心绞痛或非STEMI（NSTEMI）。MAUDE数据库检索识别出337份支架断裂报告，其中97%的病例涉及Cypher支架。193例病例有关于患者表现的临床信息。24例（12%）患者表现为STEMI或支架血栓形成，36例（19%）患者表现为不稳定型心绞痛或NSTEMI。
大多数药物洗脱支架断裂报告涉及Cypher支架。DES断裂可能与支架血栓形成、心肌梗死和心绞痛有关。然而，文献和MAUDE数据库中报告的此类事件发生率是否代表所有经历支架断裂的患者仍不明确。
