Predictors for neoatherosclerosis: a retrospective observational study from the optical coherence tomography registry.
BACKGROUND
Recent studies have reported development of neoatherosclerosis (NA) inside the stents several years after stent implantation. The aim of this study was to determine the predictors for NA using optical coherence tomography.


RESULTS
From a total of 1080 patients who underwent optical coherence tomography, we identified 179 stents in 151 patients in which the mean neointimal thickness was >100 µm. The presence of lipid-laden neointima or calcification inside the stents was defined as NA in the present study. Patient characteristics, stent type, and time since stent implantation (stent age) were compared between stents with or without NA. Univariable and multivariable logistic regression analyses were used to assess the independent predictors. In univariate analysis, stent age ≥48 months (Odds ratio [OR], 4.48; [95% CI 2.68-9.65]; P<0.001), drug-eluting stents (OR, 2.66; [95% CI, 1.38-5.16]; P=0.004), age ≥65 years (OR, 1.91; [95% CI, 1.05-3.44]; P=0.032), current smoking (OR, 2.30; [95% CI, 1.10-4.82]; P=0.024), chronic kidney disease (OR, 4.17; [95% CI, 1.42-12.23]; P=0.009), and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockade use (OR, 0.42; [95% CI, 0.22-0.80]; P=0.008) were significant predictors. In multivariate analysis, stent age ≥48 months, all subtypes of drug-eluting stent, current smoking, chronic kidney disease, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockade use remained independent predictors for NA.


CONCLUSIONS
In addition to the stent type and the stent age, patient characteristics, including current smoking, chronic kidney disease, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockade, were associated with the presence of NA. This result may support the importance of secondary prevention after stent implantation.
Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
Taishi
T
Yonetsu
Koji
K
Kato
Soo-Joong
SJ
Kim
Lei
L
Xing
Haibo
H
Jia
Iris
I
McNulty
Hang
H
Lee
Shaosong
S
Zhang
Shiro
S
Uemura
Yangsoo
Y
Jang
Soo-Jin
SJ
Kang
Seung-Jung
SJ
Park
Stephen
S
Lee
Bo
B
Yu
Tsunekazu
T
Kakuta
Ik-Kyung
IK
Jang
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058426:Neointima; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000209:etiology / Q000473:pathology