title: Optical coherence tomographic observation of in-stent neoatherosclerosis in lesions with more than 50% neointimal area stenosis after second-generation drug-eluting stent implantation.
abstract: BACKGROUND
  Despite the enhanced properties of the second-generation drug-eluting stent (DES), its association with neoatherosclerosis has not been sufficiently evaluated. Therefore, we sought to evaluate and compare neoatherosclerosis in second-generation DESs to first-generation DESs.
  
  
  RESULTS
  A total of 212 DES-treated patients with >50% percent neointimal cross-sectional area stenosis were retrospectively enrolled from the Korean multicenter optical coherence tomography (OCT) registry. Within this population, 111 patients had a second-generation DES (40 zotarolimus, 36 everolimus, and 35 biolimus) and 101 patients had a first-generation (65 sirolimus and 36 paclitaxel) DES. Neoatherosclerosis on OCT was defined as neointima formation with the presence of lipids or calcification. OCT-determined neoatherosclerosis was identified in 27.4% (58/212) of all DES-treated lesions. The frequency of neoatherosclerosis increased with the stent age. Stent age was shorter in the second-generation DES group (12.4 months versus 55.4 months, P<0.001), and neoatherosclerosis was less frequently observed in that group (10.8% versus 45.5%, P<0.001). However, after adjusting for cardiovascular risk factors, chronic kidney disease (odds ratio, 4.113; 95% confidence interval, 1.086-15.575; P=0.037), >70 mg/dL of low-density cholesterol at follow-up OCT (odds ratio, 2.532; 95% confidence interval, 1.054-6.084; P=0.038), and stent age (odds ratio, 1.710; 95% confidence interval, 1.403-2.084; P<0.001) were all independent predictors for neoatherosclerosis, whereas the type of DES (first- versus second-generation) was not. Patients with neoatherosclerosis showed a higher rate of acute coronary syndrome at follow-up OCT (19.0% versus 3.9%, respectively, P=0.001).
  
  
  CONCLUSIONS
  The second-generation DES is not more protective against neoatherosclerosis compared with the first-generation DES.
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung-Yul
authors.initials: SY
authors.lastname: Lee
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Hur
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang-Gon
authors.initials: SG
authors.lastname: Lee
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kim
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.affiliation: From the Department of Cardiology, International St. Mary's Hospital, Incheon, Korea (S.-Y.L.); Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea (S.-H.H.); Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea (S.-G.L.); Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea (S.-W.K.); Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); and Cardiovascular Institute (D.-H.S., J.-S.K., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea. mkhong61@yuhs.ac.
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; 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; D011474:Prosthesis Design; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome