The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Coronary interventions

Predictors and outcomes of neoatherosclerosis in patients with in-stent restenosis

EuroIntervention 2021;17:489-496. DOI: 10.4244/EIJ-D-20-00539

1. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; 2. Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan; 3. Division of Cardiology, Osaka General Medical Center, Osaka, Japan; 4. Division of Cardiology, Osaka Police Hospital, Osaka, Japan; 5. Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan

Background: In-stent restenosis (ISR), especially for neoatherosclerosis, is still a major problem of percutaneous coronary intervention (PCI) even in the drug-eluting stent (DES) era.

Aims: The purpose of this study was to investigate the impact of neoatherosclerosis on prognosis after PCI for ISR.

Methods: Between March 2009 and December 2017, 313 ISR lesions in patients undergoing an OCT-guided PCI in five hospitals were retrospectively enrolled. Neoatherosclerosis was defined as a lipid neointima or calcified neointima. We examined the association between neoatherosclerosis and the clinically driven target lesion revascularisation (CD-TLR) rates.

Results: In 313 ISR lesions, 64 lesions (20.4%) had bare metal stents and 241 lesions (77.0%) had drug-eluting stents (DES). Among them, 47.0% of lesions (147 lesions) had neoatherosclerosis. A multivariate logistic regression analysis demonstrated that eGFR (odds ratio [OR] 0.986, 95% confidence interval [CI]: 0.974-0.998; p=0.023), the time from PCI to the ISR (OR 1.13, 95% CI: 1.06-1.22; p<0.001) and DES-ISR (OR 2.48, 95% CI: 1.18-5.43; p=0.019) were independent predictors for neoatherosclerosis. A multivariate regression analysis demonstrated that neoatherosclerosis was an independent predictor of CD-TLR.

Conclusions: In this multicentre ISR registry, OCT imaging demonstrated that eGFR, the time from PCI to the ISR and DES-ISR were independent predictors for neoatherosclerosis and that neoatherosclerosis in ISR lesions had a worse impact on the CD-TLR rate.

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