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Usefulness of Intravascular Ultrasound Guidance in Percutaneous Coronary Intervention With Second-Generation Drug-Eluting Stents for Chronic Total Occlusions (from the Multicenter Korean-Chronic Total Occlusion Registry)

 Sung-Jin Hong  ;  Byeong-Keuk Kim  ;  Dong-Ho Shin  ;  Jung-Sun Kim  ;  Myeong-Ki Hong  ;  Hyeon-Cheol Gwon  ;  Hyo-Soo Kim  ;  Cheol Woong Yu  ;  Hun Sik Park  ;  In-Ho Chae  ;  Seung-Woon Rha  ;  Seung-Hwan Lee  ;  Moo-Hyun Kim  ;  Seung-Ho Hur  ;  Yangsoo Jang 
 AMERICAN JOURNAL OF CARDIOLOGY, Vol.114(4) : 534-540, 2014 
Journal Title
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Chronic Disease ; Coronary Angiography ; Coronary Occlusion/diagnostic imaging ; Coronary Occlusion/surgery* ; Drug-Eluting Stents* ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Percutaneous Coronary Intervention/methods* ; Postoperative Complications/epidemiology* ; Registries* ; Republic of Korea/epidemiology ; Retrospective Studies ; Surgery, Computer-Assisted/utilization* ; Treatment Outcome ; Ultrasonography, Interventional/utilization*
OBJECTIVES:The aim of this study was to investigate the correlation between in-stent neointimal tissue without features of neoatherosclerosis and long-term clinical outcomes. BACKGROUND:Recent studies have reported differential morphological characteristics of in-stent neointimal tissue assessed by optical coherence tomography (OCT). METHODS:The study population consisted of 336 patients with 368 drug-eluting stent-treated lesions. Patients received a follow-up OCT examination without any intervention. OCT-based neointima was categorized as homogeneous (n = 227 lesions in 208 patients), heterogeneous (n = 79 lesions in 73 patients), or layered (n = 62 lesions in 55 patients). Major adverse cardiac events (MACE) (a composite of cardiac death, nonfatal myocardial infarction, or target lesion revascularization) were assessed according to neointimal patterns during long-term clinical follow-up after OCT examination. RESULTS:The time interval between stent implantation and OCT examination was similar among the 3 groups (p = 0.64). On multivariate logistic regression analysis, the significant determinant for the heterogeneous neointima was age (odds ratio [OR]: 1.037, 95% confidence interval [CI]: 1.007 to 1.068, p = 0.015) and an initial clinical presentation of acute coronary syndrome (OR: 1.967, 95% CI: 1.159 to 3.339, p = 0.012). The overall median follow-up duration for all patients after follow-up OCT examination was 31.0 months, and this was statistically different among the heterogeneous group (22.0 months), the homogeneous group (34.0 months), and the layered group (28.0 months, overall p = 0.002). MACE occurred more frequently in patients with heterogeneous neointima over a median 31-month follow-up period after OCT examination (13.7% vs. 2.9% in homogeneous vs. 7.3% in layered, p = 0.001). A propensity score-adjusted Cox regression analysis showed that independent risk factors for MACE were inclusion in the heterogeneous neointima (hazard ratio: 3.925, 95% CI: 1.445 to 10.662, p = 0.007) and minimal lumen cross-sectional area (hazard ratio: 0.368, 95% CI: 0.242 to 0.560, p < 0.001). CONCLUSIONS:Determination of neointimal characteristics is helpful in predicting long-term clinical outcomes. Our data suggest that heterogeneous lesions are linked to poor long-term clinical prognoses.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
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
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
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