Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Am J Cardiol. 2010 Oct 15;106(8):1075-80. doi: 10.1016/j.amjcard.2010.06.010.
A meta-analysis of published studies was conducted to evaluate the incidence, predictors, and clinical outcomes of stent fractures. Eight studies with 108 stent fractures in 5,321 patients were analyzed using the Bayesian method. Study end points included in-stent restenosis (ISR) and target lesion revascularization (TLR). The mean incidence of stent fracture per patient was 4.0% (95% confidence interval 0.4% to 16.3%). All cases, except 1, were reported with sirolimus-eluting stents. The incidence of stent fracture was 30.4% in the left anterior descending coronary artery, 10.9% in the left circumflex coronary artery, 56.4% in the right coronary artery, < 0.01% in the left main coronary artery, and 1.7% in saphenous vein grafts. The probability of stent fracture was significantly higher in the right coronary artery than in the left anterior descending and left circumflex lesions (p < 0.01). Left main stents were less likely to fracture compared to those in all other vessels (p < 0.01). The probability of stent fracture was significantly increased in overlapping stents (7.5% vs 2.1%, p = 0.01) and long stents (46 vs 32.5 mm, p < 0.01). Lesions with stent fractures had higher rates of ISR (38% vs 8.2%, p < 0.01) and TLR (17% vs 5.6%, p < 0.01). Conversely, the probability of stent fractures was higher in patients with ISR (12.8% vs 2.1%, p < 0.01) and TLR (8.8% vs 2.7%, p < 0.01). In conclusion, although not always associated with clinical sequelae, the probability of ISR and TLR is increased with stent fracture. Conversely, the probability of stent fractures is increased in lesions with ISR or TLR, thus raising the need for surveillance and management guidelines for at-risk patients.
进行了一项已发表研究的荟萃分析，以评估支架断裂的发生率、预测因素和临床结果。使用贝叶斯方法分析了 8 项研究，共纳入 5321 例患者的 108 例支架断裂。研究终点包括支架内再狭窄（ISR）和靶病变血运重建（TLR）。每位患者支架断裂的平均发生率为 4.0%（95%置信区间为 0.4%至 16.3%）。除 1 例外，所有病例均报告使用西罗莫司洗脱支架。在前降支冠状动脉、左旋支冠状动脉、右冠状动脉、左主干冠状动脉和大隐静脉桥中的支架断裂发生率分别为 30.4%、10.9%、56.4%、<0.01%和 1.7%。与前降支和左旋支病变相比，右冠状动脉支架断裂的概率明显更高（p<0.01）。与其他所有血管相比，左主干支架发生断裂的可能性较低（p<0.01）。重叠支架（7.5%比 2.1%，p=0.01）和长支架（46 毫米比 32.5 毫米，p<0.01）的支架断裂概率显著增加。支架断裂的病变 ISR 发生率（38%比 8.2%，p<0.01）和 TLR 发生率（17%比 5.6%，p<0.01）均较高。相反，ISR（12.8%比 2.1%，p<0.01）和 TLR（8.8%比 2.7%，p<0.01）患者的支架断裂概率较高。总之，尽管支架断裂并不总是与临床后果相关，但与支架断裂相关的 ISR 和 TLR 发生率增加。相反，ISR 或 TLR 病变的支架断裂概率增加，因此需要为高危患者制定监测和管理指南。
