Kuramitsu Shoichi, Jinnouchi Hiroyuki, Shinozaki Tomohiro, Hiromasa Takashi, Matsumura Yukiko, Yamaji Yuhei, Miura Mizuki, Matsuda Hiroaki, Masuda Hisaki, Domei Takenori, Soga Yoshimitsu, Hyodo Makoto, Shirai Shinichi, Ando Kenji
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Am J Cardiol. 2017 Jul 1;120(1):55-62. doi: 10.1016/j.amjcard.2017.03.259. Epub 2017 Apr 12.
The incidence and long-term clinical impact of stent fracture (SF) occurred beyond 1 year after sirolimus-eluting stent (SES) implantation remains unclear. From April 2004 to March 2008, 985 consecutive patients with 1,307 lesions were treated only with SES. Of these, 868 patients (88.1%) with 1,140 lesions underwent follow-up angiography within 1 year after the index procedure, and 646 patients (65.6%) with 872 lesions underwent it both within and beyond 1 year after the index procedure. According to the diagnosed timing of SF, we divided the patients into the 2 groups: early SF (<1 year after the index procedure) and late-acquired SF (>1 year after the index procedure). Early- and late-acquired SFs were observed in 64 of 868 patients (7.4%) and 66 of 1,140 lesions (5.8%); 12 of 646 patients (1.9%) and 12 of 872 lesions (1.4%), respectively. Cumulative 10-year incidence of clinically driven target lesion revascularization and definite stent thrombosis were numerically higher in the early- and late-acquired SF groups than in the non-SF group (41.6% vs 45.5% vs 19.0%; 8.0% vs 8.3% vs 2.0%, respectively). In conclusion, late-acquired SF after SES implantation occurred in 1.4% of lesions, which was lower than that of early SF. However, both early- and late-acquired SFs appeared to be associated with clinically driven target lesion revascularization and stent thrombosis during the long-term follow-up.
西罗莫司洗脱支架（SES）植入术后1年以上发生支架断裂（SF）的发生率及其长期临床影响尚不清楚。2004年4月至2008年3月，连续985例患者的1307处病变仅接受了SES治疗。其中，868例患者（88.1%）的1140处病变在首次手术后1年内接受了随访血管造影，646例患者（65.6%）的872处病变在首次手术后1年内及1年以上均接受了随访血管造影。根据SF的诊断时间，我们将患者分为两组：早期SF（首次手术后<1年）和迟发性SF（首次手术后>1年）。在868例患者中有64例（7.4%）观察到早期获得性SF，在1140处病变中有66处（5.8%）；在646例患者中有12例（1.9%），在872处病变中有12处（1.4%）观察到迟发性SF。早期和迟发性SF组临床驱动的靶病变血运重建和明确的支架血栓形成累积10年发生率在数值上高于非SF组（分别为41.6%对45.5%对19.0%；8.0%对8.3%对2.0%）。总之，SES植入术后迟发性SF发生在1.4%的病变中低于早期SF。然而，在长期随访中，早期和迟发性SF似乎均与临床驱动的靶病变血运重建和支架血栓形成有关。
