{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T14:34:17Z","timestamp":1782398057198,"version":"3.54.5"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2011,8]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Although stent fracture (SF) after sirolimus-eluting stent (SES) implantation has been recognized as one of the predisposing factors of in-stent restenosis, it remains uncertain whether SF can increase the risk of major adverse cardiac events (MACE), especially beyond 1 year after SES implantation. The aim of this study was to assess the impact of SF relative to non-SF on 4-year clinical outcomes after treatment with SES of comparable unselected lesions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              A total of 874 lesions in 793 patients undergoing SES implantation and subsequent angiography 6 to 9 months after index procedure were analyzed. At 6- to 9-month angiographic follow-up, SF was identified in 70 of 874 lesions (8.0%). In-stent late loss was significantly higher in SF lesions versus non-SF lesions (0.42\u00b10.59 mm versus 0.13\u00b10.49 mm,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), resulting in a significantly higher in-stent restenosis rate (21.4% versus 4.1%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). At 4 years, SF versus non-SF was associated with a significantly higher MACE rate (23.2% versus 12.6%,\n              <jats:italic>P<\/jats:italic>\n              =0.014), mainly driven by significantly higher target-lesion revascularization (18.8% versus 10.2%,\n              <jats:italic>P<\/jats:italic>\n              =0.029) rate. Adverse effects of SF on clinical outcomes occurred mostly within the first year (17.4% versus 6.6%,\n              <jats:italic>P<\/jats:italic>\n              =0.001), with similar MACE rate between 1 and 4 years (5.8% versus 5.9%,\n              <jats:italic>P<\/jats:italic>\n              =0.611). No significant differences between SF versus non-SF patients were observed in the cumulative frequency of very late stent thrombosis (2.9% versus 1.4%,\n              <jats:italic>P<\/jats:italic>\n              =0.281), death (0% versus 2.1%,\n              <jats:italic>P<\/jats:italic>\n              =0.252), or myocardial infarction (5.8% versus 2.9%,\n              <jats:italic>P<\/jats:italic>\n              =0.165).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>SF of SES was associated with higher MACE rate up to 1 year, mainly driven by higher target-lesion revascularization, whereas no significant association was evident between years 1 and 4.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.110.958306","type":"journal-article","created":{"date-parts":[[2011,8,3]],"date-time":"2011-08-03T04:03:11Z","timestamp":1312344191000},"page":"349-354","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Impact of Sirolimus-Eluting Stent Fracture on 4-Year Clinical Outcomes"],"prefix":"10.1161","volume":"4","author":[{"given":"Hisashi","family":"Umeda","sequence":"first","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Kawai","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Misumida","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Ota","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazutaka","family":"Hayashi","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsunori","family":"Iwase","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Izawa","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeo","family":"Sugino","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Shimizu","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Takeichi","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoji","family":"Ishiki","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruo","family":"Inagaki","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukio","family":"Ozaki","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toyoaki","family":"Murohara","sequence":"additional","affiliation":[{"name":"From the Division of Cardiology, Toyota Memorial Hospital, Toyota, Japan (H.U., N.M., T.O., K.H., S.S., R.I., H.I.); the Department of Cardiology, Fujita Health University, Toyoake, Japan (T.K., Y.O.); the Division of Integrated Medicine, Toyota Memorial Hospital, Toyota, Japan (M.I., Y.T.); the Department of Cardiology, Bantane Hospital, Fujita Health University, Nagoya, Japan (H.I.); the Division of Cardiology, Aichi Prefectural Cardiovascular and Respiratory Center, Ichinomiya, Japan (T.S.); and..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000150331.14687.4b"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.01.050"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.04.077"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706258"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.20950"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.20942"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.03.073"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.71.1669"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2007.12.067"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2008.10.013"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-09-0343"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.12.022"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.05.075"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067731"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.07.035"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.10709"},{"key":"e_1_3_3_18_2","first-page":"439","article-title":"Stent fracture and restenosis of a paclitaxel-eluting stent","volume":"46","author":"Hamilos MI","year":"2005","unstructured":"Hamilos MI, Papafaklis MI, Ligthart JM, Serruys PW, Sianos G . 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