BackgroundAlmost all data about DES fracture are those of first generation DES such as Cypher Bx짰, Taxus Express짰. However, those of the widely used later generation DES including Cypher Select짰(CS), Taxus짰LibertéTM(TL), Endeavor짰(EN) and XienceTM V(XV) have not yet been studied. ObjectiveTo identify the the incidence, predictors and clinical outcomes of later generation DES fracture.MethodsWe retrospectively analyzed clinical and angiographic data of 1518 stented segments with later generation DES in 1245 patients who underwent follow-up CAG at 5 Catholic Medical Centers.ResultsOf 1518 lesions, 635 lesions were implanted with CS, 411 lesions with TL, 110 lesions with EN and 362 lesions with XV. Total 19 stent fractures (SF) (1.25%) were identified and there was no difference in the incidence of SF between stent type (CS;1.7%,TL;0.97%,EN;0%,XV;1.1%,p=0.15). Interestingly, no SF was found in the lesions implanted with EN stent. Lesions with SF showed higher incidence of B2/C lesions(100% vs 57.5%, p=0.001), smaller reference diameter(3.18짹0.3 vs 3.37짹0.4mm, p=0.01), longer lesion length(45.5짹16.2 vs 24.7짹13mm, p<0.001), higher incidence of lesion angulation>45째(35% vs11.8%, p=0.007), longer total stent length(48.3짹16.8 vs 26.3짹13.2mm, p<0.001) and more frequent stent overlapping(57.9% vs 18.5%, p<0.001) than those without SF. The binary restenosis(42.1% vs 6.6%, p<0.001) and TLR(47.3% vs 6.2%, p<0.001) rate in patients with SF were much higher than those without it. Total stent length(OR=1.18, 95% CI 1.03 to 1.33, p=0.012), lesion angulation>45째(OR=7.6, 95% CI 2.2 to 26.3, p=0.001), RCA stenting(OR=5.14, 95% CI 1.62 to 16.3, p=0.005) were identified as significant independent predictors of SF.ConclusionsThe implantation of later generation DES may reduce the occurrence of SF. However, the rate of binary restenosis and TLR related with it is still high. And lesion characteristics on initial CAG are more important than implanted stent type to predict SF in later generation DES era.