第二代药物洗脱支架植入术后内膜增生面积狭窄超过50%的病变中支架内新生动脉粥样硬化的光学相干断层扫描观察
Optical coherence tomographic observation of in-stent neoatherosclerosis in lesions with more than 50% neointimal area stenosis after second-generation drug-eluting stent implantation.
作者信息
Lee Seung-Yul, Hur Seung-Ho, Lee Sang-Gon, Kim Sang-Wook, Shin Dong-Ho, Kim Jung-Sun, Kim Byeong-Keuk, Ko Young-Guk, Choi Donghoon, Jang Yangsoo, Hong Myeong-Ki
机构信息
From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
出版信息
Circ Cardiovasc Interv. 2015 Feb;8(2):e001878. doi: 10.1161/CIRCINTERVENTIONS.114.001878.
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.
背景
尽管第二代药物洗脱支架（DES）性能有所增强，但其与新生动脉粥样硬化的关联尚未得到充分评估。因此，我们试图评估并比较第二代DES与第一代DES中的新生动脉粥样硬化情况。
方法与结果
从韩国多中心光学相干断层扫描（OCT）注册研究中回顾性纳入了212例接受DES治疗且新生内膜横截面积狭窄>50%的患者。在该人群中，111例患者植入第二代DES（40例佐他莫司、36例依维莫司和35例生物可吸收涂层依维莫司），101例患者植入第一代DES（65例西罗莫司和36例紫杉醇）。OCT上的新生动脉粥样硬化定义为伴有脂质或钙化的新生内膜形成。在所有接受DES治疗的病变中，OCT确定的新生动脉粥样硬化在27.4%（58/212）的病变中被识别出。新生动脉粥样硬化的发生率随支架植入时间增加。第二代DES组的支架植入时间较短（12.4个月对55.4个月，P<0.001），且该组中新生动脉粥样硬化的发生率较低（10.8%对45.5%，P<0.001）。然而，在调整心血管危险因素后，慢性肾脏病（比值比，4.113；95%置信区间，1.086 - 15.575；P = 0.037）、随访OCT时低密度胆固醇>70mg/dL（比值比，2.532；95%置信区间，1.054 - 6.084；P = 0.038）以及支架植入时间（比值比，1.710；95%置信区间，1.403 - 2.084；P<0.001）均为新生动脉粥样硬化的独立预测因素，而DES类型（第一代与第二代）则不是。有新生动脉粥样硬化的患者在随访OCT时急性冠状动脉综合征的发生率更高（分别为19.0%对3.9%，P = 0.001）。
结论
与第一代DES相比，第二代DES对新生动脉粥样硬化并无更强的防护作用。
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