Impact of baseline plaque characteristic on the development of neoatherosclerosis in the very late phase after stenting

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BackgroundNeoatherosclerosis (NA) is recognized as an important contributing factor to very late stent failure. The aim of this study was to investigate whether preprocedural underlying plaque morphology is associated with the development of NA using optical coherence tomography (OCT). MethodsOne-hundred thirteen stents [25 bare metal stents, 22 first-generation drug-eluting stents (DES), 66 second-generation DES] from 98 patients who underwent percutaneous coronary intervention with pre-percutaneous coronary intervention (PCI) OCT and very late OCT examination >3 years after stenting were retrospectively studied. In OCT analysis, NA was defined as a neointima with lipid or calcification. In-stent lipid volume index was defined as the in-stent averaged lipid arc multiplied by in-stent lipid length. ResultsIn all, 28 stents were implanted to the culprit lesions of acute coronary syndrome (ACS) and 85 stents were in stable lesions. NA was observed in 29 stents (25.7%) and the median duration from PCI to remote OCT examination was 5.1 (4.0–6.1) years. Multivariable logistic regression analysis revealed that low-density lipoprotein cholesterol (LDL-C) at follow-up OCT [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01–1.04, p<0.001], stent age (OR 2.13, 95% CI 1.36–3.31, p=0.001), and thin-cap fibroatheroma (TCFA) at baseline culprit lesions (OR 14.2, 95% CI 4.6–43.8, p<0.001) were independent predictors for the development of NA. In multiple linear regression analysis, in-stent lipid volume index was significantly correlated with LDL-C at follow-up OCT, stent age, the target lesion of ACS, and OCT-TCFA at baseline. ConclusionIn addition to the known predictors, underlying plaque characteristics at the time of stenting was significantly associated with the development of NA at approximately 5 years after stent implantation.