Optical coherence tomographic observation of in-stent neoatherosclerosis in lesions with more than 50% neointimal area stenosis after second-generation drug-eluting stent implantation

Seung Yul Lee, Seung Ho Hur, Sang Gon Lee, Sang Wook Kim, Dong Ho Shin, Jung Sun Kim, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Myeongki Hong

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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 firstgeneration (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 secondgeneration 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 firstgeneration DES.

Original languageEnglish
Article numbere001878
JournalCirculation: Cardiovascular Interventions
Volume8
Issue number2
DOIs
Publication statusPublished - 2015 Feb 1

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Drug-Eluting Stents
Stents
Pathologic Constriction
Observation
Optical Coherence Tomography
Odds Ratio
Confidence Intervals
Neointima
Sirolimus
Acute Coronary Syndrome
Paclitaxel
Registries
Cholesterol
Lipids

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{45d366940c9749658bfcfd9bc9af6aec,
title = "Optical coherence tomographic observation of in-stent neoatherosclerosis in lesions with more than 50{\%} neointimal area stenosis after second-generation drug-eluting stent implantation",
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 firstgeneration (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 secondgeneration 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 firstgeneration DES.",
author = "Lee, {Seung Yul} and Hur, {Seung Ho} and Lee, {Sang Gon} and Kim, {Sang Wook} and Shin, {Dong Ho} and Kim, {Jung Sun} and Kim, {Byeong Keuk} and Ko, {Young Guk} and Donghoon Choi and Yangsoo Jang and Myeongki Hong",
year = "2015",
month = "2",
day = "1",
doi = "10.1161/CIRCINTERVENTIONS.114.001878",
language = "English",
volume = "8",
journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
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}

Optical coherence tomographic observation of in-stent neoatherosclerosis in lesions with more than 50% neointimal area stenosis after second-generation drug-eluting stent implantation. / 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, Myeongki.

In: Circulation: Cardiovascular Interventions, Vol. 8, No. 2, e001878, 01.02.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Optical coherence tomographic observation of in-stent neoatherosclerosis in lesions with more than 50% neointimal area stenosis after second-generation drug-eluting stent implantation

AU - Lee, Seung Yul

AU - Hur, Seung Ho

AU - Lee, Sang Gon

AU - Kim, Sang Wook

AU - Shin, Dong Ho

AU - Kim, Jung Sun

AU - Kim, Byeong Keuk

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Jang, Yangsoo

AU - Hong, Myeongki

PY - 2015/2/1

Y1 - 2015/2/1

N2 - 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 firstgeneration (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 secondgeneration 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 firstgeneration DES.

AB - 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 firstgeneration (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 secondgeneration 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 firstgeneration DES.

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U2 - 10.1161/CIRCINTERVENTIONS.114.001878

DO - 10.1161/CIRCINTERVENTIONS.114.001878

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VL - 8

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

SN - 1941-7640

IS - 2

M1 - e001878

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