冠状动脉支架置入后 3 至 7 年晚期观察到的新生动脉粥样硬化的临床意义。
Clinical significance of neoatherosclerosis observed at very late phase between 3 and 7 years after coronary stent implantation.
机构信息
Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, 300-0028 Ibaraki, Japan.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
J Cardiol. 2021 Jul;78(1):58-65. doi: 10.1016/j.jjcc.2021.01.005. Epub 2021 Jan 27.
BACKGROUND
Clinical significance of neoatherosclerosis (NA) observed at very late phase remains undetermined. We sought to investigate the association between NA observed by optical coherence tomography (OCT) 3-7 years after stenting and subsequent clinical outcomes.
METHODS
We investigated previously implanted stents without stent failure in the institutional OCT database at Tsuchiura Kyodo General Hospital. Qualitative and quantitative OCT analyses were performed. In patient-based analysis, major adverse cardiac events (MACE) included all-cause death, non-fatal myocardial infarction, and clinically driven revascularization. MACE-free survival rate was compared between patients with any stent showing NA (NA group) and those without NA (non-NA group). In stent-based analysis, the stent failure including target-lesion revascularization and stent thrombosis after the belated OCT examination were assessed.
RESULTS
A total of 187 patients with 308 stents undergoing belated OCT examination 3-7 years after implantation were investigated. Median duration from implantation to the belated OCT was 4.8 (3.8-5.8) years and NA was identified in 48 stents (15.6%) in 36 patients (19.3%). In patient-based analysis, during the median of 2.9 (2.1-3.6) years after belated OCT, MACE occurred in 9 patients (25.0%) with at least one stent showing NA (NA group) and 9 patients (6.0%) without NA (non-NA group) (p=0.002). Cox regression analysis revealed that NA was an independent predictor of MACE [hazard ratio (HR) 4.14 (1.58- 10.8), p=0.004]. In stent-based analysis, 7 stent failures were documented (stents with NA 10.0% vs. stents without NA 0.8%, p<0.01). NA was a significant predictor of stent failure [HR 9.17 (1.67- 50.3), p=0.011] at OCT examinations.
CONCLUSIONS
NA observed by OCT 3-7 years after implantation was associated with subsequent worse clinical outcomes in both patient-based and stent-based analysis.
背景
在极晚期观察到的新生动脉粥样硬化（NA）的临床意义仍未确定。我们旨在研究光学相干断层扫描（OCT）检查发现支架置入 3-7 年后的 NA 与随后临床结局之间的关系。
方法
我们在土浦共荣医院的机构 OCT 数据库中调查了先前未发生支架内失败的植入支架。进行了定性和定量 OCT 分析。在患者为基础的分析中，主要不良心脏事件（MACE）包括全因死亡、非致死性心肌梗死和临床驱动的血运重建。比较了支架内有任何支架显示 NA（NA 组）和无 NA（非 NA 组）的患者之间的 MACE 无事件生存率。在支架为基础的分析中，评估了延迟 OCT 检查后的支架内失败，包括靶病变血运重建和支架血栓形成。
结果
共对 187 名患者的 308 个支架进行了调查，这些支架在植入后 3-7 年接受了延迟 OCT 检查。从植入到延迟 OCT 的中位时间为 4.8（3.8-5.8）年，48 个支架（15.6%）在 36 名患者（19.3%）中显示出 NA。在患者为基础的分析中，在延迟 OCT 后中位 2.9（2.1-3.6）年期间，至少有一个支架显示 NA（NA 组）的 9 名患者（25.0%）和无 NA（非 NA 组）的 9 名患者（6.0%）发生了 MACE（p=0.002）。Cox 回归分析显示，NA 是 MACE 的独立预测因子[危险比（HR）4.14（1.58-10.8），p=0.004]。在支架为基础的分析中，记录了 7 例支架内失败（有 NA 的支架为 10.0%，无 NA 的支架为 0.8%，p<0.01）。NA 是 OCT 检查中支架内失败的显著预测因子[HR 9.17（1.67-50.3），p=0.011]。
结论
支架置入后 3-7 年 OCT 检查发现的 NA 与患者为基础和支架为基础的分析中的后续临床结局恶化相关。
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