Jang Ji-Yong, Kim Jung-Sun, Shin Dong-Ho, Kim Byeong-Keuk, Ko Young-Guk, Choi Donghoon, Jang Yangsoo, Hong Myeong-Ki
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea.
Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, South Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Atherosclerosis. 2015 Oct;242(2):553-9. doi: 10.1016/j.atherosclerosis.2015.08.014. Epub 2015 Aug 12.
Serial follow-up optical coherence tomography (OCT) was used to evaluate the effect of optimal lipid-lowering therapy on qualitative changes in neointimal tissue characteristics after drug-eluting stent (DES) implantation.
DES-treated patients (n = 218) who received statin therapy were examined with serial follow-up OCT. First and second follow-up OCT evaluations were performed approximately 6 and 18 months after the index procedure, respectively. Patients were divided into two groups, based on the level of low-density lipoprotein-cholesterol (LDL-C), which was measured at the second follow-up. The optimal lipid-lowering group (n = 121) had an LDL-C reduction of ≥50% or an LDL-C level ≤70 mg/dL, and the conventional group (n = 97). Neointimal characteristics were qualitatively categorized as homogeneous or non-homogeneous patterns using OCT. The non-homogeneous group included heterogeneous, layered, or neoatherosclerosis patterns. Qualitative changes in neointimal tissue characteristics between the first and second follow-up OCT examinations were assessed.
Between the first and second follow-up OCT procedures, the neointimal cross-sectional area increased more substantially in the conventional group (0.4 mm(2) vs. 0.2 mm(2) in the optimal lipid-lowering group, p = 0.01). The neointimal pattern changed from homogeneous to non-homogeneous less often in the optimal lipid-lowering group (1.3%, 1/77, p < 0.001) than in the conventional group (15.3%, 11/72, p = 0.44). Optimal LDL-C reduction was an independent predictor for the prevention of neointimal pattern change from homogeneous to non-homogeneous (odds ratio: 0.05, 95% confidence interval: 0.01∼0.46, p = 0.008).
Our findings suggest that an intensive reduction in LDL-C levels can prevent non-homogeneous changes in the neointima and increases in neointimal cross-sectional area compared with conventional LDL-C controls.
采用系列随访光学相干断层扫描（OCT）评估最佳降脂治疗对药物洗脱支架（DES）植入后新生内膜组织特征性变化的影响。
对接受他汀类治疗的DES治疗患者（n = 218）进行系列随访OCT检查。首次和第二次随访OCT评估分别在索引手术大约6个月和18个月后进行。根据第二次随访时测量的低密度脂蛋白胆固醇（LDL-C）水平将患者分为两组。最佳降脂组（n = 121）的LDL-C降低≥50%或LDL-C水平≤70 mg/dL，常规组（n = 97）。使用OCT将新生内膜特征定性分类为均匀或不均匀模式。不均匀组包括异质、分层或新动脉粥样硬化模式。评估首次和第二次随访OCT检查之间新生内膜组织特征的定性变化。
在首次和第二次随访OCT检查之间，常规组新生内膜横截面积增加更为显著（最佳降脂组为0.4 mm²，常规组为0.2 mm²，p = 0.01）。最佳降脂组新生内膜模式从均匀变为不均匀的情况（1.3%，1/77，p < 0.001）比常规组（15.3%，11/72，p = 0.44）少。最佳LDL-C降低是预防新生内膜模式从均匀变为不均匀的独立预测因素（比值比：0.05，95%置信区间：0.01∼0.46，p = 0.008）。
我们的研究结果表明，与常规LDL-C控制相比，LDL-C水平的强化降低可预防新生内膜的不均匀变化和新生内膜横截面积的增加。
