Comparison between Plain Old Balloon Angioplasty and Drug-Eluting Stent Implantation for the Treatment of Stent Fracture

Objectives: The aim of this study was to evaluate clinical outcomes after percutaneous coronary intervention (PCI) for stent fracture (SF). Background: SF has been reported as a predictor of in-stent restenosis (ISR) and stent thrombosis (ST). Methods: Between January 2009 and December 2012, consecutive SF cases treated with either drug-eluting stent (DES) or plain old balloon angioplasty (POBA) were retrospectively enrolled in this study. The study endpoints were all-cause death, cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), ST, re-stent fracture (re-SF), and major adverse cardiac events (MACE) defined as the composite of cardiac death, MI, and TLR. Results: Of 135 SF cases, 67 (49.6%) cases were treated with DES, whereas 68 (50.4%) cases with POBA. Median follow-up period was 1,401 (IQR: 967-1,771) days. The estimated MACE rate at 3 years was significantly lower in the DES group as compared with the POBA group largely driven by less TLR (25.7 vs. 55.8%, P<0.001). Moreover, 1-year landmark analysis after PCI for SF revealed that MACE continued to occur even after 1 year irrespective of the treatment option (P = 0.47). On multivariable Cox regression analysis, POBA and large post-procedure angle (D) defined as the degree difference between the end systolic and diastolic angle were identified as independent predictors for TLR. Conclusions: DES implantation for SF is associated with better clinical outcomes as compared to POBA alone, due to a lower need for TLR. Large post-procedural angle (D) appears to be an independent predictor of TLR.