Purpose Several authors reported stent fracture(SF) after Sirolimus-eluting stent(SES) implantation and suggested possible association with adverse outcome like restenosis. However, studies based on angiographic follow-up can be misleading in that underestimation of real incidence and overestimation of restenosis can occur. Methods We performed simple fluoroscopic surveillance for all implanted stents in patients who are underwent coronary intervention using SES from our institution between January 2003 and October 2005. We evaluated the incidence, predictors, and clinical prognosis of SF in whom angiographic and IVUS confirmation after fluoroscopic surveillance was performed. Results Total 881 stents in 572 patients were included in this analysis and follow up was completed for 804 stens(91.3%) in 542 patients(94.8%). The median time interval from stent implantation to detection of SF was 255days(range, 6 to 720days). SF was found in 4.4% of stents(39/881) and 7% of patients(38/542) and the incidence of SF was significantly higher in RCA lesions(61.5%vs.23.9%,p<0.001), longer stent length(40.1짹18.5vs.30.5짹12.0,p=0.001), and overlapped stents(33.3%vs.15.2%,p=0.003). Other variables, like stent diameter, maximal inflation pressure and balloon:artery ratio, were not different significantly. By multivariate analysis, target vessel location on right coronary artery(odds ratio[OR] 13.76, 95% confidence intervel[CI] ), lesion length(OR 1.04, 95% CI 1.00-1.08) and total stent length(OR 1.35, 95% CI 1.138-1.596) were identified as independent correlates. Angiographic adverse outcomes at the SF site were found in only two patients; Except for target lesion revascularization in left anterior descending artery SF, there were neither major adverse cardiac events including stent thrombosis nor in stent restenosis during follow-up periods. Conclusion Meticulous fluoroscopic surveillance revealed that SF occurred in 7% of cases after SES implantation. The predictors of SF were target vessel location, lesion length and total stent length. SF after SES implantation was not associated with angiographic restenosis or adverse clinical outcomes.