title: The impact of in-stent neoatherosclerosis on long-term clinical outcomes: an observational study from the Kobe University Hospital optical coherence tomography registry.
abstract: OBJECTIVE
  Although pathological studies have indicated the development of neoatherosclerosis (NA) after stenting, its risk factors and impact on future clinical events remain unclear. We aimed to clarify the possible risk factors for NA development and to evaluate the impact of NA in a large Japanese observational OCT database of patients with coronary heart disease.
  
  
  RESULTS
  One hundred and seventy-five consecutive patients (314 lesions) who underwent OCT examination >1 year after bare metal or drug-eluting stent implantation were enrolled. We assessed the presence of NA by follow-up OCT and compared adverse clinical events between NA+ and NA- patients. Forty-six patients had NA at the follow-up OCT. These patients had higher low-density lipoprotein (LDL) cholesterol and C-reactive protein (CRP) levels at follow-up. In multivariate logistic analysis, LDL cholesterol and CRP levels at follow-up were independently associated with the presence of NA (odds ratio [OR]: 1.022, p=0.008, OR 1.022, p=0.001, respectively). Moreover, patients with NA had a higher incidence of major adverse cardiac events (MACE) at follow-up. Multivariate Cox hazard analysis showed that the presence of NA was an independent risk factor for MACE (hazard ratio: 2.909, p=0.012).
  
  
  CONCLUSIONS
  High LDL cholesterol and CRP levels may be risk factors for NA development in patients treated with coronary stents. Moreover, the presence of NA was independently associated with MACE, suggesting the need for careful clinical follow-up of these patients.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kuroda
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Takaya
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Osue
authors.forename: Yu
authors.initials: Y
authors.lastname: Taniguchi
authors.forename: Masamichi
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishio
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kinutani
authors.forename: Akihide
authors.initials: A
authors.lastname: Konishi
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Hirata
mesh_terms: D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000628:therapy*; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012042:Registries; D012307:Risk Factors; D013995:Time; D041623:Tomography, Optical Coherence / Q000379:methods