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Optical coherence tomographic observation of in-stent neoatherosclerosis in lesions with more than 50% neointimal area stenosis after second-generation drug-eluting stent implantation

Authors
 Seung-Yul Lee  ;  Seung-Ho Hur  ;  Sang-Gon Lee  ;  Sang-Wook Kim  ;  Dong-Ho Shin  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Myeong-Ki Hong 
Citation
 CIRCULATION-CARDIOVASCULAR INTERVENTIONS, Vol.8(2) : 001878, 2015 
Journal Title
 CIRCULATION-CARDIOVASCULAR INTERVENTIONS 
ISSN
 1941-7640 
Issue Date
2015
MeSH
Aged ; Chi-Square Distribution ; Coronary Artery Disease/pathology ; Coronary Artery Disease/therapy* ; Coronary Restenosis/etiology* ; Coronary Restenosis/pathology ; Coronary Restenosis/prevention & control ; Coronary Vessels/pathology* ; Drug-Eluting Stents* ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Neointima* ; Odds Ratio ; Percutaneous Coronary Intervention/adverse effects* ; Percutaneous Coronary Intervention/instrumentation* ; Predictive Value of Tests ; Prosthesis Design ; Registries ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Time Factors ; Tomography, Optical Coherence* ; Treatment Outcome
Keywords
atherosclerosis ; drug-eluting stent ; optical coherence tomography
Abstract
BACKGROUND: Despite the enhanced properties of the second-generation drug-eluting stent (DES), its association with neoatherosclerosis has not been sufficiently evaluated. Therefore, we sought to evaluate and compare neoatherosclerosis in second-generation DESs to first-generation DESs. METHODS AND RESULTS: A total of 212 DES-treated patients with >50% percent neointimal cross-sectional area stenosis were retrospectively enrolled from the Korean multicenter optical coherence tomography (OCT) registry. Within this population, 111 patients had a second-generation DES (40 zotarolimus, 36 everolimus, and 35 biolimus) and 101 patients had a first-generation (65 sirolimus and 36 paclitaxel) DES. Neoatherosclerosis on OCT was defined as neointima formation with the presence of lipids or calcification. OCT-determined neoatherosclerosis was identified in 27.4% (58/212) of all DES-treated lesions. The frequency of neoatherosclerosis increased with the stent age. Stent age was shorter in the second-generation DES group (12.4 months versus 55.4 months, P<0.001), and neoatherosclerosis was less frequently observed in that group (10.8% versus 45.5%, P<0.001). However, after adjusting for cardiovascular risk factors, chronic kidney disease (odds ratio, 4.113; 95% confidence interval, 1.086-15.575; P=0.037), >70 mg/dL of low-density cholesterol at follow-up OCT (odds ratio, 2.532; 95% confidence interval, 1.054-6.084; P=0.038), and stent age (odds ratio, 1.710; 95% confidence interval, 1.403-2.084; P<0.001) were all independent predictors for neoatherosclerosis, whereas the type of DES (first- versus second-generation) was not. Patients with neoatherosclerosis showed a higher rate of acute coronary syndrome at follow-up OCT (19.0% versus 3.9%, respectively, P=0.001). CONCLUSIONS: The second-generation DES is not more protective against neoatherosclerosis compared with the first-generation DES.
Full Text
http://circinterventions.ahajournals.org/content/8/2/e001878.long
DOI
10.1161/CIRCINTERVENTIONS.114.001878
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shin, Dong Ho(신동호) ORCID logo https://orcid.org/0000-0002-7874-5542
Lee, Seung Yul(이승율)
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/140464
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