title: Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents.
abstract: Although reported in bare metal stents (BMS) and first-generation drug-eluting stents (DES), little is known about neoatherosclerosis in second-generation DES. We used optical coherence tomography to evaluate neoatherosclerosis among different stent generations. Overall, 274 in-stent restenosis (ISR) lesions (duration from implantation 56.9 ± 47.2 months) in 274 patients were assessed for the presence of neoatherosclerosis. Neoatherosclerosis was identified in 38.7% of lesions (106/274): 23.0% second-generation DES (38/165), 65.1% first-generation DES (54/83), and 53.8% BMS (14/26). In the neoatherosclerosis cohort (n = 106), more stent underexpansion or fracture/deformation was observed in second-generation DES, whereas thrombus, without plaque rupture, or evagination was more common in first-generation DES. In multivariable analyses, duration from implantation >1 year (OR: 2.44, 95% CI 1.12-5.31; p = 0.03), absence of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (OR 1.95, 95% CI 1.10-3.44; p = 0.02) or statins at the time of ISR (OR 3.12, 95% CI 1.42-6.84; p = 0.01), and first-generation vs first-generation DES (OR 5.32, 95% CI 2.82-10.10; p < 0.001) correlated with a higher prevalence of neoatherosclerosis. Duration from implantation <1 year (OR 2.17, 95% CI 1.03-4.55; p = 0.04) and thin fibrous cap, thrombus, or rupture (OR 2.72, 95% CI 1.15-6.39; p = 0.02) were independent predictors for acute coronary syndromes presentation. Neoatherosclerosis is an important ISR mechanism, especially in first generation DES.
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.|Nation Center for Cardiovascular Disease, China Peking Union Medical College, Fuwai Hospital, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Song
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.|Nation Center for Cardiovascular Disease, China Peking Union Medical College, Fuwai Hospital, Beijing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Yin
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
authors.forename: Myong Hwa
authors.initials: MH
authors.lastname: Yamamoto
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.|National Heart Centre Singapore, Singapore, Singapore.
authors.forename: Chee Yang
authors.initials: CY
authors.lastname: Chin
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Matsumura
authors.affiliation: New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
authors.forename: Khady
authors.initials: K
authors.lastname: Fall
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
authors.forename: Manish A
authors.initials: MA
authors.lastname: Parikh
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Ali
authors.affiliation: St. Francis Hospital, Roslyn, NY, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Shlofmitz
authors.affiliation: Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA. amaehara@crf.org.|New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA. amaehara@crf.org.
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Bare metal stent; Drug-eluting stent; Imaging; In-stent restenosis; Optical coherence tomography