Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan.
J Cardiol. 2019 Jul;74(1):67-73. doi: 10.1016/j.jjcc.2019.01.002. Epub 2019 Feb 4.
Neoatherosclerosis (NA) is recognized as an important contributing factor to very late stent failure. The aim of this study was to investigate whether preprocedural underlying plaque morphology is associated with the development of NA using optical coherence tomography (OCT).
One-hundred thirteen stents [25 bare metal stents, 22 first-generation drug-eluting stents (DES), 66 second-generation DES] from 98 patients who underwent percutaneous coronary intervention with pre-percutaneous coronary intervention (PCI) OCT and very late OCT examination >3 years after stenting were retrospectively studied. In OCT analysis, NA was defined as a neointima with lipid or calcification. In-stent lipid volume index was defined as the in-stent averaged lipid arc multiplied by in-stent lipid length.
In all, 28 stents were implanted to the culprit lesions of acute coronary syndrome (ACS) and 85 stents were in stable lesions. NA was observed in 29 stents (25.7%) and the median duration from PCI to remote OCT examination was 5.1 (4.0-6.1) years. Multivariable logistic regression analysis revealed that low-density lipoprotein cholesterol (LDL-C) at follow-up OCT [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.04, p<0.001], stent age (OR 2.13, 95% CI 1.36-3.31, p=0.001), and thin-cap fibroatheroma (TCFA) at baseline culprit lesions (OR 14.2, 95% CI 4.6-43.8, p<0.001) were independent predictors for the development of NA. In multiple linear regression analysis, in-stent lipid volume index was significantly correlated with LDL-C at follow-up OCT, stent age, the target lesion of ACS, and OCT-TCFA at baseline.
In addition to the known predictors, underlying plaque characteristics at the time of stenting was significantly associated with the development of NA at approximately 5 years after stent implantation.
新生动脉粥样硬化（NA）被认为是导致晚期支架失败的一个重要因素。本研究旨在通过光学相干断层扫描（OCT）探讨术前潜在斑块形态是否与 NA 的发生有关。
回顾性分析 98 例患者的 113 个支架[25 个裸金属支架、22 个第一代药物洗脱支架（DES）、66 个第二代 DES]，这些患者在经皮冠状动脉介入治疗（PCI）前行 PCI 术前 OCT 检查，且在支架置入后 >3 年进行了晚期 OCT 检查。在 OCT 分析中，NA 定义为富含脂质或钙化的新生内膜。支架内脂质体积指数定义为支架内平均脂质弧乘以支架内脂质长度。
共 28 个支架植入急性冠状动脉综合征（ACS）罪犯病变，85 个支架植入稳定病变。29 个支架（25.7%）观察到 NA，从 PCI 到远程 OCT 检查的中位时间为 5.1（4.0-6.1）年。多变量逻辑回归分析显示，随访 OCT 中的低密度脂蛋白胆固醇（LDL-C）[比值比（OR）1.03，95%置信区间（CI）1.01-1.04，p<0.001]、支架年龄（OR 2.13，95%CI 1.36-3.31，p=0.001）和基线罪犯病变中的薄帽纤维粥样斑块（TCFA）（OR 14.2，95%CI 4.6-43.8，p<0.001）是 NA 发生的独立预测因素。在多元线性回归分析中，支架内脂质体积指数与随访 OCT 中的 LDL-C、支架年龄、ACS 的靶病变和基线 OCT-TCFA 显著相关。
除了已知的预测因素外，支架置入时的潜在斑块特征与支架置入后约 5 年发生 NA 显著相关。
