title: Optical coherence tomography-based predictors for creatine kinase-myocardial band elevation after elective percutaneous coronary intervention for in-stent restenosis.
abstract: OBJECTIVE
  We evaluated whether morphological characteristics of neointimal tissue of in-stent restenosis (ISR) lesions assessed by optical coherence tomography (OCT) affect periprocedural elevation of creatine kinase-myocardial band (CK-MB).
  
  
  BACKGROUND
  The impact of neointimal characteristics of ISR lesions on periprocedural myocardial injury has not been sufficiently investigated.
  
  
  METHODS
  A total of 125 patients with ISR lesions underwent elective percutaneous coronary intervention (PCI) and pre-PCI OCT examination. Measurements of CK-MB were performed upon hospitalization, before PCI, and every 8 hr for 24 hr after PCI. CK-MB elevation was defined as levels above the 99th percentile of the upper reference limit. Neoatherosclerosis was defined as neointima with lipid or calcification.
  
  
  RESULTS
  Post-PCI CK-MB elevation was observed in 20 (16.0%) patients. The maximum length of consecutive cross-sections with neoatherosclerosis on the longitudinal axis of the stent was significantly larger in patients with post-PCI CK-MB elevation than in those without [8.8 mm (1.5-10.4) vs. 0.0 mm (0.0-1.0), P < 0.001], and thin-cap fibroatheroma (TCFA) were more frequently observed at the site of minimal lumen cross-sectional area in patients with post-PCI CK-MB elevation (55.0% vs. 1.9%, P < 0.001). Multivariate analysis revealed that the maximum length of segments with neoatherosclerosis [odds ratio (OR), 1.463; 95% confidence interval (CI), 1.090-1.962; P = 0.011] and TCFA (OR, 14.328; 95% CI, 1.118-183.628; P = 0.041) were independent predictors for post-PCI CK-MB elevation.
  
  
  CONCLUSIONS
  A greater axial length of neoatherosclerosis and the presence of TCFA at the most stenotic site were significantly associated with post-PCI CK-MB elevation in ISR lesions.
authors.affiliation: Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung-Yul
authors.initials: SY
authors.lastname: Lee
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058426:Neointima; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D011237:Predictive Value of Tests; D019233:Retreatment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D015854:Up-Regulation; D061205:Vascular Calcification / Q000209:etiology / Q000628:therapy
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form
keywords: in-stent restenosis; neoatherosclerosis; optical coherence tomography