In-Stent Neoatherosclerosis and Native Coronary Disease Progression| Journal Scan

Study Questions:

What is the relationship between in-stent neoatherosclerosis and progression of native atherosclerosis in untreated coronary segments?

Methods:

The authors assessed for neoatherosclerosis using optical coherence tomography (OCT) among patients included in the SIRTAX-LATE OCT study 5 years after implantation of first-generation drug-eluting stent (DES). 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), and change in minimal lumen diameter was assessed within matched segments at baseline and 5-year angiographic follow-up.

Results:

The study population was comprised of a total of 88 stented lesions in 88 patients that were available for OCT analysis 5 years after DES implantation. In-stent neoatherosclerosis was observed in 16% of lesions, with the majority of plaques being fibroatheromas (11.4%) followed by fibrocalcific plaques (5.7%). Non–target lesion assessment with QCA was done for 704 segments. Over the 5-year period, there was a greater reduction in the minimal lumen diameter in patients with in-stent neoatherosclerosis (-0.25 mm, 95% confidence interval [CI], -0.36 to -0.17 mm) compared with patients without neoatherosclerosis (-0.13 mm, 95% CI, -0.17 to -0.10 mm; p = 0.002). Over the 5-year study period, non–target lesion revascularization was more frequent in patients with neoatherosclerosis (78.6%) when compared with patients without neoatherosclerosis (44.6%, p = 0.028).

Conclusions:

In-stent neoatherosclerosis was more common among patients with angiographic and clinical evidence of native atherosclerosis progression.

Perspective:

Late failure of first-generation DES is increasingly being recognized, and the pathophysiology appears to be neointimal atherosclerosis rather than smooth muscle cell restenosis. This study demonstrates a close relationship between in-stent neoatherosclerosis and native coronary disease progression, and raises the possibility that more aggressive risk factor control might be successful at reducing the progression on atherosclerosis in both the stented and the nonstented segments of the coronary tree.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Angiography, Atherosclerosis, Coronary Angiography, Coronary Artery Disease, Coronary Disease, Disease Progression, Drug-Eluting Stents, Myocytes, Smooth Muscle, Neointima, Plaque, Atherosclerotic, Risk Factors, Stents, Tomography, Optical Coherence


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