title: The association between in-stent neoatherosclerosis and native coronary artery disease progression: a long-term angiographic and optical coherence tomography cohort study.
abstract: OBJECTIVE
  The purpose of the present study was to investigate the relationship between in-stent neoatherosclerosis (NA) and native atherosclerosis progression of untreated coronary segments.
  
  
  RESULTS
  In-stent NA was assessed by optical coherence tomography (OCT) among patients included in the SIRTAX-LATE OCT study 5 years after drug-eluting stent (DES) (sirolimus-eluting and paclitaxel-eluting stents) implantation. Neoatherosclerosis was defined as the presence of fibroatheroma or fibrocalcific plaque within the neointima of stented segments with a longitudinal extension >1.0 mm. Atherosclerosis progression in untreated native coronary segments was evaluated by serial quantitative coronary angiography (QCA). The change in minimal lumen diameter (MLD) was serially assessed within matched segments at baseline and 5-year angiographic follow-up. The key clinical endpoint was non-target lesion (non-TL) revascularization throughout 5 years. A total of 88 patients with 88 lesions were available for OCT analysis 5 years after DES implantation. In-stent NA was observed in 16% of lesions with the majority of plaques being fibroatheromas (11.4%) followed by fibrocalcific plaques (5.7%). A total of 704 non-TL segments were serially evaluated by QCA. Between baseline and 5-year follow-up, the reduction in MLD was significantly more pronounced in patients with NA (-0.25 mm, 95% CI -0.36 to -0.17 mm) when compared with patients without NA (-0.13 mm, 95% CI -0.17 to -0.10 mm, P = 0.002). Similarly, non-TL revascularization was more frequent in patients with NA (78.6%) when compared with patients without NA (44.6%, P = 0.028) throughout 5 years.
  
  
  CONCLUSIONS
  In-stent NA is more common among patients with angiographic and clinical evidence of native atherosclerosis progression suggesting similar pathophysiological mechanisms.SIRTAX trial is registered at http://www.clinicaltrials.gov/ct2/show/NCT00617084.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Masanori
authors.initials: M
authors.lastname: Taniwaki
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.affiliation: Clinical Trials Unit, Bern University, Bern, Switzerland.
authors.forename: Serge
authors.initials: S
authors.lastname: Zaugg
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Giulio G
authors.initials: GG
authors.lastname: Stefanini
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Sandro
authors.initials: S
authors.lastname: Baumgartner
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zanchin
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern 3010, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.affiliation: Institute of Primary Health Care, University of Bern, Bern, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern 3010, Switzerland lorenz.raeber@insel.ch.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000473:pathology; D023921:Coronary Stenosis / Q000473:pathology* / Q000601:surgery; D018450:Disease Progression; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage; D011475:Prosthesis Failure; D020123:Sirolimus / Q000008:administration & dosage; D041623:Tomography, Optical Coherence / Q000379:methods; D050257:Tubulin Modulators / Q000008:administration & dosage
chemical_list: D050257:Tubulin Modulators; D017239:Paclitaxel; D020123:Sirolimus
keywords: Drug-eluting stent; Long-term outcomes; Neoatherosclerosis; Paclitaxel-eluting stent; Sirolimus-eluting stent; Target lesion revascularization