Optical Coherence Tomographic Observation of In-Stent Neoatherosclerosis in Lesions With More Than 50% Neointimal Area Stenosis After Second-Generation Drug-Eluting Stent Implantation
- Authors
- Lee, Seung-Yul; Hur, Seung-Ho; Lee, Sang-Gon; Kim, Sang-Wook; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo; Hong, Myeong-Ki
- Issue Date
- Feb-2015
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- atherosclerosis; drug-eluting stent; optical coherence tomography
- Citation
- CIRCULATION-CARDIOVASCULAR INTERVENTIONS, v.8, no.2
- Journal Title
- CIRCULATION-CARDIOVASCULAR INTERVENTIONS
- Volume
- 8
- Number
- 2
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/9929
- DOI
- 10.1161/CIRCINTERVENTIONS.114.001878
- ISSN
- 1941-7640
1941-7632
- Abstract
- Background-Despite the enhanced properties of the second-generation drug-eluting stent (DES), its association with neoatherosclerosis has not been sufficiently evaluated. Therefore, we sought to evaluate and compare neoatherosclerosis in second-generation DESs to first-generation DESs. Methods and Results-A total of 212 DES-treated patients with >50% percent neointimal cross-sectional area stenosis were retrospectively enrolled from the Korean multicenter optical coherence tomography (OCT) registry. Within this population, 111 patients had a second-generation DES (40 zotarolimus, 36 everolimus, and 35 biolimus) and 101 patients had a first-generation (65 sirolimus and 36 paclitaxel) DES. Neoatherosclerosis on OCT was defined as neointima formation with the presence of lipids or calcification. OCT-determined neoatherosclerosis was identified in 27.4% (58/212) of all DES-treated lesions. The frequency of neoatherosclerosis increased with the stent age. Stent age was shorter in the second-generation DES group (12.4 months versus 55.4 months, P<0.001), and neoatherosclerosis was less frequently observed in that group (10.8% versus 45.5%, P<0.001). However, after adjusting for cardiovascular risk factors, chronic kidney disease (odds ratio, 4.113; 95% confidence interval, 1.086-15.575; P=0.037), >70 mg/dL of low-density cholesterol at follow-up OCT (odds ratio, 2.532; 95% confidence interval, 1.054-6.084; P=0.038), and stent age (odds ratio, 1.710; 95% confidence interval, 1.403-2.084; P<0.001) were all independent predictors for neoatherosclerosis, whereas the type of DES (first-versus second-generation) was not. Patients with neoatherosclerosis showed a higher rate of acute coronary syndrome at follow-up OCT (19.0% versus 3.9%, respectively, P=0.001). Conclusions-The second-generation DES is not more protective against neoatherosclerosis compared with the first-generation DES.
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