Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
Division of Advanced Cardiovascular Imaging, Department of Medicine, Nihon University School of Medicine.
J Atheroscler Thromb. 2022 Apr 1;29(4):536-550. doi: 10.5551/jat.60954. Epub 2021 Mar 21.
Smaller low-density lipoprotein (LDL) particle size has been suggested to result in the development of endothelial dysfunction, atherosclerosis, and in-stent restenosis (ISR); however, little is known regarding the impact of the LDL particle size on the neointima formation leading to ISR after everolimus-eluting stent (EES) implantation.
In this study, we have included 100 patients to examine the relationship between an LDL-C/apolipoprotein B (Apo B) ≤ 1.2, reportedly representing the LDL particle size, and the neointimal characteristics using optical coherence tomography (OCT) and coronary angioscopy (CAS) during the follow-up coronary angiography (CAG) period (8.8±2.5 months) after EES implantation. We divided them into two groups: LDL-C/Apo B ≤ 1.2 group (low LDL-C/Apo B group, n=53) and LDL-C/Apo B ＞1.2 group (high LDL-C/Apo B group, n=47).
The low LDL-C/Apo B group had a significantly larger neointimal volume (12.8±5.3 vs. 10.3±4.9 mm, p=0.021) and lower incidence of a neointimal homogeneous pattern (71 vs. 89 %), higher incidence of a neointimal heterogeneous pattern (25 vs. 9 %) (p=0.006) and higher prevalence of macrophage accumulation (9 vs. 2 %) (p=0.030) as assessed via OCT, and, as per the CAS findings, a higher prevalence of yellow grade ≥ 2 (grade 2; adjusted residual: 2.94, grade 3; adjusted residual: 2.00, p=0.017) than the high LDL-C/Apo B group.
A low LDL-C/Apo B ratio was found to be strongly associated with neointimal proliferation and neointimal instability evidenced chronically by OCT and CAS. An LDL-C/Apo B ≤ 1.2 will be of aid in terms of identifying high-risk patients after EES implantation.
较小的低密度脂蛋白（LDL）颗粒大小被认为会导致内皮功能障碍、动脉粥样硬化和支架内再狭窄（ISR）的发生；然而，对于 LDL 颗粒大小对导致依维莫司洗脱支架（EES）植入后 ISR 的新生内膜形成的影响知之甚少。
在这项研究中，我们纳入了 100 例患者，通过光学相干断层扫描（OCT）和冠状动脉血管镜（CAS）检查 LDL-C/载脂蛋白 B（Apo B）≤1.2，据报道这代表 LDL 颗粒大小，并在 EES 植入后的随访冠状动脉造影（CAG）期间（8.8±2.5 个月）检查新生内膜特征。我们将他们分为两组：LDL-C/Apo B≤1.2 组（低 LDL-C/Apo B 组，n=53）和 LDL-C/Apo B＞1.2 组（高 LDL-C/Apo B 组，n=47）。
低 LDL-C/Apo B 组的新生内膜体积显著更大（12.8±5.3 与 10.3±4.9mm，p=0.021），新生内膜均匀模式的发生率更低（71%与 89%，p=0.006），新生内膜不均匀模式的发生率更高（25%与 9%，p=0.006），巨噬细胞堆积的发生率更高（9%与 2%，p=0.030），OCT 评估，根据 CAS 检查结果，黄色等级≥2（等级 2；调整残差：2.94，等级 3；调整残差：2.00，p=0.017）的发生率高于高 LDL-C/Apo B 组。
低 LDL-C/Apo B 比值与 OCT 和 CAS 长期证实的新生内膜增殖和新生内膜不稳定性密切相关。LDL-C/Apo B≤1.2 将有助于识别 EES 植入后的高危患者。
