Goryo Yutaka, Kume Teruyoshi, Ueda Tomoya, Watanabe Makoto, Yamada Ryotaro, Neishi Yoji, Saito Yoshihiko, Uemura Shiro
Department of Cardiology, Kawasaki Medical School, Kurashiki.
First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
Acta Cardiol Sin. 2018 Mar;34(2):124-129. doi: 10.6515/ACS.201803_34(2).20171115A.
To evaluate the neointimal conditions of everolimus-eluting stents (EESs) implanted in culprit lesions of patients with acute coronary syndrome (ACS) compared with stable angina pectoris (SAP) using optical coherence tomography (OCT). EESs are second-generation drug-eluting stents that have recently been shown to be useful in patients with ACS as well as in patients with SAP. However, few studies have analyzed the intra-stent conditions of EESs that can lead to favorable results in such ACS lesions.
We evaluated 41 ACS patients with EES implantation (age, 66.7 ± 10.3 years) and 59 SAP patients enrolled as controls (age, 68.3 ± 10.7 years). OCT examinations were performed after 9 months of follow-up after stent implantation, and the condition of the neointimal coverage over every stent strut was assessed in 1-mm intervals. In addition, neointimal thickness (NIT) over each strut was measured and tissue characteristics were examined.
There was no significant difference in mean NIT between the ACS (90.8 ± 88.2 mm) and SAP (87.3 ± 74.2 mm, p = 0.11) group. The rate of uncovered struts was significantly lower in the ACS group (11.5%) than in the SAP group (12.5%, p = 0.03). Neointimal tissue characteristics were also similar between groups.
Vascular responses after EES implantation differed significantly between ACS and SAP lesions using OCT. However, these differences were considered small in clinical terms. Our OCT data support the favorable results of patients with EES implantation at mid-term follow-up, even in those with ACS.
使用光学相干断层扫描（OCT）评估在急性冠状动脉综合征（ACS）患者与稳定型心绞痛（SAP）患者的罪犯病变中植入依维莫司洗脱支架（EES）后的新生内膜情况。EES是第二代药物洗脱支架，最近已证明其对ACS患者和SAP患者均有用。然而，很少有研究分析EES的支架内情况，而这可能会在这类ACS病变中带来良好结果。
我们评估了41例植入EES的ACS患者（年龄66.7±10.3岁）和59例作为对照的SAP患者（年龄68.3±10.7岁）。在支架植入后9个月的随访后进行OCT检查，并以1毫米间隔评估每个支架支柱上新生内膜覆盖的情况。此外，测量每个支柱上的新生内膜厚度（NIT）并检查组织特征。
ACS组（90.8±88.2毫米）和SAP组（87.3±74.2毫米，p = 0.11）的平均NIT无显著差异。ACS组未覆盖支柱的比例（11.5%）显著低于SAP组（12.5%，p = 0.03）。两组之间的新生内膜组织特征也相似。
使用OCT时，EES植入后ACS和SAP病变的血管反应存在显著差异。然而，从临床角度来看，这些差异被认为较小。我们的OCT数据支持EES植入患者在中期随访中的良好结果，即使是ACS患者。
