Abstract 4300: Incidence, Clinical Characteristics and Implications of Coronary Stent Fracture: A Meta-analysis of 5321 Patients
Background Coronary stent fracture is a recently identified complication of drug-eluting stents; however, the clinical implications of stent fracture remain unclear. We thus conducted a meta-analysis of published studies to evaluate the incidence, predictors and clinical outcomes of stent fractures.
Methods We analyzed 8 studies with 108 stent fractures in 5321 patients by Bayesian method. Study end-points included in-stent restenosis (ISR) and target-lesion revascularization (TLR). The probability of stent fracture was calculated by random and fixed effects models.
Results The mean incidence of stent fracture per patient was 4.0 % (95% CI 0.4%–16.3%). All cases, except one, were reported in sirolimus-eluting stents. The incidence of stent fracture was 30.4% in left anterior descending (LAD) artery, 10.9 % in left circumflex (LCx), 56.4% in right coronary artery (RCA), <0.01 % in left main coronary (LM) artery and 1.7 % in saphenous vein grafts. The probability of stent fracture was significantly higher in RCA than LAD and LCx lesions (p<0.01). LM stents were less likely to fracture as compared to all other vessels (p<0.01). The probability of stent fracture was significantly increased in overlapping stents (5.4% vs. 1.4%, p=0.01) and long stents [46mm (fractured stents) vs. 32.5mm (non-fractured stents), p<0.01]. Lesions with stent fractures had a higher rate of ISR (38% versus 8.2%, P<0.01) and TLR (17% versus 5.6%, P<0.01) (Table 1⇓). 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) (Table 1⇓).
Discussion Our meta-analysis reveals that although not always associated with clinical sequelae, the incidence of ISR and TLR is significantly higher in patients with stent fracture. Conversely, the probability of stent fractures is increased in lesions with ISR or TLR, thus emphasizing the need for surveillance guidelines in the management of at-risk patients.