European Radiology

, Volume 24, Issue 5, pp 1006–1012 | Cite as

Impact of sirolimus-eluting stent fractures without early cardiac events on long-term clinical outcomes: A multislice computed tomography study

  • Tsuyoshi Ito
  • Masashi Kimura
  • Mariko Ehara
  • Mitsuyasu Terashima
  • Kenya Nasu
  • Yoshihisa Kinoshita
  • Maoto Habara
  • Etsuo Tsuchikane
  • Takahiko Suzuki
Cardiac
First Online:
Received:
Revised:
Accepted:

Abstract

Objectives

This study sought to evaluate the impact of sirolimus-eluting stent (SES) fractures on long-term clinical outcomes using multislice computed tomography (MSCT).

Methods

In this study, 528 patients undergoing 6- to 18-month follow-up 64-slice MSCT after SES implantation without early clinical events were followed clinically (the median follow-up interval was 4.6 years). A CT-detected stent fracture was defined as a complete gap with Hounsfield units (HU) <300 at the site of separation. The major adverse cardiac events (MACEs), including cardiac death, stent thrombosis, and target lesion revascularisation, were compared according to the presence of stent fracture.

Results

Stent fractures were observed in 39 patients (7.4 %). MACEs were more common in patients with CT-detected stent fractures than in those without (46 % vs. 7 %, p < 0.01). Univariate Cox regression analysis indicated a significant relationship between MACE and stent fracture [hazard ratio (HR) 7.65; p < 0.01], age (HR 1.03; p = 0.04), stent length (HR 1.03; p < 0.01), diabetes mellitus (HR 1.77; p = 0.04), and chronic total occlusion (HR 2.54; p = 0.01). In the multivariate model, stent fracture (HR 5.36; p < 0.01) and age (HR 1.03; p = 0.04) remained significant predictors of MACE.

Conclusions

An SES fracture detected by MSCT without early clinical events was associated with long-term clinical adverse events.

Key points

• Long-term outcomes of sirolimus-eluting stent fracture have not been fully clarified.

• MSCT could detect stent fracture with high accuracy.

• Sirolimus-eluting stent fracture detected by MSCT was associated with long-term adverse events.

Keywords

Coronary artery disease Drug-eluting stents Sirolimus Multislice computed tomography Outcome assessment 

Abbreviations and acronyms

CAG

coronary angiography

CTO

chronic total occlusion

HU

Hounsfield unit

IVUS

intravascular ultrasound

MACE

major adverse cardiac events

MSCT

multislice computed tomography

PCI

percutaneous coronary intervention

QCA

quantitative coronary angiography

SES

sirolimus-eluting stent

TLR

target lesion revascularisation

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Notes

Acknowledgements

The scientific guarantor of this publication is Takahiko Suzuki. The authors of this manuscript declare no relationships with any companies whose products or services could be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this article. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, observational, performed at one institution.

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Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Tsuyoshi Ito
    • 1
    • 2
  • Masashi Kimura
    • 1
  • Mariko Ehara
    • 1
  • Mitsuyasu Terashima
    • 1
  • Kenya Nasu
    • 1
  • Yoshihisa Kinoshita
    • 1
  • Maoto Habara
    • 1
  • Etsuo Tsuchikane
    • 1
  • Takahiko Suzuki
    • 1
  1. 1.Toyohashi Heart CenterOyama-choJapan
  2. 2.Department of Cardio-Renal Medicine and HypertensionNagoya City University Graduate School of Medical SciencesNagoyaJapan

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