Biscaglia Simone, Tebaldi Matteo, Tumscitz Carlo, Pavasini Rita, Marchesini Jlenia, Gallo Francesco, Spitaleri Giosafat, Zaraket Fatima, Serenelli Matteo, Cimaglia Paolo, Bugani Giulia, Campo Gianluca
Cardiovascular Institute, Medical Sciences Department, Azienda Ospedaliero-Universitaria S.Anna.
Circ J. 2016 Dec 22;81(1):82-89. doi: 10.1253/circj.CJ-16-0785. Epub 2016 Nov 17.
No study has evaluated the clinical consequences of stent fracture (SF) detected during the index percutaneous coronary intervention (PCI). Thus, we sought to investigate the relationship between SF detected during PCI and clinical outcome.
We consecutively enrolled 832 patients with SF-predisposing factors undergoing 2nd-generation drug-eluting stent implantation and enhanced stent visualization (ESV) system evaluation to detect SF at index PCI. The primary endpoint was a 9-month device-oriented endpoint (DOCE, including cardiac death, target vessel myocardial infarction, and target lesion revascularization). We observed 136 SF in 115 patients (14% of study population). SF I-II was present in 78 patients (68% of patients with SF), and SF III-IV occurred in 37 patients (32%). DOCE at 9 months occurred in 135 patients (16% of the overall population). There was a significant difference in DOCE occurrence between the 3 groups (P=0.006 at log-rank), driven by the SF III-IV group (P=0.001 vs. no SF group, and P=0.01 vs. SF I-II group). In 23 cases of SF III-IV (62%) a further stent was implanted. DOCE occurrence was significantly higher in patients with "untreated" type III-IV SF as compared with the "treated" ones (9% vs. 79%, P<0.01).
The ESV system is helpful in detecting SF during the index PCI. Type III-IV SFs are associated with a higher incidence of DOCE.
尚无研究评估在首次经皮冠状动脉介入治疗（PCI）期间检测到的支架断裂（SF）的临床后果。因此，我们试图研究PCI期间检测到的SF与临床结局之间的关系。
我们连续纳入了832例具有SF易患因素的患者，这些患者接受了第二代药物洗脱支架植入和增强支架可视化（ESV）系统评估，以在首次PCI时检测SF。主要终点是9个月时的器械相关终点（DOCE，包括心源性死亡、靶血管心肌梗死和靶病变血运重建）。我们在115例患者中观察到136处SF（占研究人群的14%）。78例患者出现I-II级SF（占SF患者的68%），37例患者出现III-IV级SF（占32%）。9个月时发生DOCE的患者有135例（占总人群的16%）。三组之间DOCE的发生率存在显著差异（对数秩检验P=0.006），由III-IV级SF组驱动（与无SF组相比P=0.001，与I-II级SF组相比P=0.01）。在23例III-IV级SF病例中（62%）再次植入了支架。与“已治疗”的患者相比，“未治疗”的III-IV级SF患者DOCE的发生率显著更高（9%对79%，P<0.01）。
ESV系统有助于在首次PCI期间检测SF。III-IV级SF与较高的DOCE发生率相关。
