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Objectives: To evaluate long-term clinical outcomes of overlapping heterogeneous drug-eluting stents (DES) compared with homogeneous DES. Design and setting The catholic medical centre coronary intervention database is a multicentre database of percutaneous coronary intervention with DES. This database contains data on consecutive patients from eight coronary intervention centres in Korea. Patients: Overlapping homogeneous DES were used in 940 patients and overlapping heterogeneous DES in 140 patients between January 2005 and June 2010. Intervention: The study enrolled patients with one-vessel disease treated with two overlapping DES in one lesion. Main outcome measures The study end point was the occurrence of major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction (MI) or target lesion revascularisation (TRL). Results: The two patient groups had similar baseline clinical and angiographic characteristics. MACE, cardiac death, MI and TRL rates, were not significantly different between the homogeneous and heterogeneous DES groups (9.9% vs 11.4%, p¼0.574; 2.7% vs 3.6%, p¼0.578; 1.5% vs 1.4%, p¼1.000; 5.7% vs 6.4%, p¼0.747, respectively). In addition, it was found that overlap with second generation DES may be safe and effective, and the sirolimus-eluting stent (SES)+SES group had higher rate of MACE-free survival than the paclitaxel-eluting stent (PES)+PES group (p¼0.014). Conclusions: Overlapping heterogeneous DES and overlapping homogeneous DES had similar long-term safety and efficacy outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cases of stent strut fractures (SSFs) after DES implantation have been reported, but the clinical significance is uncertain. Then we sought to define the incidence and clinical implications of SSFs developed after drug-eluting stent (DES) implantation. Methods: We gathered SSF cases from 13 centers in Korea retrospectively. SSF was defined as angiographically visible interrupted connection of stent struts or fewer visible stent struts at the suspected site than normally looking stented area on intravascular ultrasound (IVUS). Furthermore, we classified the SSFs cases into three patterns (disruption, avulsion, and displacement) according to the interruption site and absence or presence of displacement. Results: Thirty-seven SSFs (2 disruption, 7 avulsion, 28 displacement) were detected in 35 lesions in 35 patients. All fractured stents were sirolimus-eluting stents (SESs). The incidence of SSFs was 0.84% and the proportion of restenosis related with SSF was 6.3% after SES implantation driven from the data of 8 centers. The average length of stent used was 49 mm, overlapping stenting was performed in 19 lesions (54%), and the average maximal angulation in the initial coronary angiography was 67°. Twenty-four fractures (65%) were associated with focal in stent restenosis and 11 fractures (30%) with target lesion revascularization. No acute coronary syndrome developed. Conclusions: SSF after DES implantation might be a considerable complication after DES implantation especially after SES implantation. [Copyright &y& Elsevier]