Abstract
The prognosis of stented lesions differs according to in-stent neointimal characteristics on optical coherence tomography (OCT). In particular, patients who show in-stent heterogeneous neointima are associated with a higher incidence of target lesion revascularization (TLR) compared with those who show in-stent non-heterogeneous neointima. However, the relationship between in-stent neointimal characteristics and native coronary atherosclerosis progression has not been clearly elucidated. The study aimed to investigate the relationship between in-stent neointimal characteristics and progression of native atherosclerosis. The neointimal characteristics of 377 patients with 377 drug-eluting stents (DESs) were quantitatively and qualitatively assessed using OCT. The OCT-based neointima was categorized as homogeneous (n = 207), heterogeneous (n = 93), and layered (n = 77). The relationship of non-target lesion revascularization (non-TLR) with neointimal characteristics was evaluated after OCT examination of the stents. After a median follow-up duration of 40.0 months, patients with heterogeneous neointima showed significantly higher non-TLR rates than those with homogeneous neointima and tended to have higher non-TLR rates than those with layered neointima (heterogeneous vs. homogeneous:14.0% vs. 8.7%, p = 0.046; heterogeneous vs. layered neointima:14.0% vs. 7.8%, p = 0.152). Multivariate analysis showed that the independent determinants for non-TLR were heterogeneous neointima (HR: 2.237, 95% CI: 1.023-4.890, p = 0.044) and chronic kidney disease (hazard ratio [HR]: 8.730, 95% CI: 2.175-35.036, p = 0.002). The heterogeneous neointima in DES-treated lesions was associated with a higher incidence of non-TLR and target lesion failure. This finding suggests that the neointimal pattern may reflect the progression of the native lesion.
Highlights
The prognosis of stented lesions may differ according to the in-stent neointimal characteristics observed on optical coherence tomography (OCT) [1,2,3]
Multivariate analysis showed that the independent determinants for nonTLR were heterogeneous neointima (HR: 2.237, 95% CI: 1.023–4.890, p = 0.044) and chronic kidney disease
The heterogeneous neointima in drug-eluting stent (DES)-treated lesions was associated with a higher incidence of non-target lesion revascularization (TLR) and target lesion failure
Summary
The prognosis of stented lesions may differ according to the in-stent neointimal characteristics observed on optical coherence tomography (OCT) [1,2,3]. Patients who show instent heterogeneous neointimal growth are associated with a higher incidence of target lesion revascularization (TLR) compared with those who show in-stent non-heterogeneous neointimal growth [1, 2]. In this study, we aimed to this study to investigate the relationship between in-stent neointimal characteristics and native atherosclerosis progression in untreated coronary segments using OCT in patients who underwent percutaneous coronary intervention (PCI) with drug-eluting stent (DES). The prognosis of stented lesions differs according to in-stent neointimal characteristics on optical coherence tomography (OCT). Patients who show in-stent heterogeneous neointima are associated with a higher incidence of target lesion revascularization (TLR) compared with those who show in-stent non-heterogeneous neointima. The study aimed to investigate the relationship between in-stent neointimal characteristics and progression of native atherosclerosis
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