The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)
Clinical outcomes by optical characteristics of neointima and treatment modality in patients with coronary in-stent restenosis
Erion Xhepa1; Jola Bresha2; Michael Joner3; Alexander Hapfelmeier4; Fernando Rivero5; Gjin Ndrepepa2; Nejva Nano2; Javier Cuesta5; Sebastian Kufner2; Salvatore Cassese2; Teresa Bastante5; Alp Aytekin2; Andi Rroku2; Marcos Garcia Guimaraes5; Anna Lena Lahmann2; Susanne Pinieck2; Himanshu Rai2; Massimiliano Fusaro2; Heribert Schunkert3; Maria Jose Perez Vizcayno6; Nieves Gonzalo6; Fernando Alfonso5; Adnan Kastrati3;
1. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München,Technical University of Munich, Germany, Germany 2. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany 3. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany 4. Institute of General Practice and Health Services Research, Technical University of Munich, Germany; Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Germany 5. Hospital Universitario de La Princesa, IIS-IP, CIBER-CV, Universidad Autónoma de Madrid. Madrid, Spain 6. Hospital Clínico San Carlos, IdISSC, Universidad Complutense Madrid, Madrid, Spain
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Aims First, to assess the relation between neointimal pattern and clinical outcomes following in-stent restenosis (ISR) treatment; second, to explore a potential interaction between neointimal pattern and treatment modality relative to clinical outcomes.
Methods and results Based on the distribution of non-homogeneous quadrants, patients undergoing optical coherence tomography (OCT) prior to drug-eluting stent (DES) or drug-coated balloon (DCB) treatment of ISR, were categorized in low and high inhomogeneity groups (100 and 97 patients respectively). There were no significant differences in terms of MACE (P=0.939) or TLR (P=0.732). The exploratory analysis showed a significant interaction between neointimal pattern and treatment modality regarding MACE (Pint=0.006) and TLR (Pint=0.022). DES showed a significant advantage over DCB in the high [MACE: HR 0.26 (0.10-0.65), P=0.004; TLR: HR 0.28 (0.11-0.69), P=0.006], but not in the low inhomogeneity group (MACE: P=0.917; TLR: P=0.797).
Conclusions In patients with ISR treated with DCB or DES, there were no significant differences in terms of MACE or TLR between low and high inhomogeneity groups. A significant interaction was observed between treatment modality and neointimal pattern with an advantage of DES over DCB in the high and no difference in the low inhomogeneity group. This warrants confirmation from prospective dedicated studies.