Stent age ≥48 months (OR 4.48; 95% CI 2.68-9.65), drug-eluting stents, smoking, and chronic kidney disease independently predicted neoatherosclerosis, whereas ACEI/ARB use was protective.
Observational (n=151)
Effect estimate: OR 4.48 (95% CI 2.68-9.65)
p-value: p=<0.001
BACKGROUND: Recent studies have reported development of neoatherosclerosis (NA) inside the stents several years after stent implantation. The aim of this study was to determine the predictors for NA using optical coherence tomography. METHODS AND RESULTS: From a total of 1080 patients who underwent optical coherence tomography, we identified 179 stents in 151 patients in which the mean neointimal thickness was >100 µm. The presence of lipid-laden neointima or calcification inside the stents was defined as NA in the present study. Patient characteristics, stent type, and time since stent implantation (stent age) were compared between stents with or without NA. Univariable and multivariable logistic regression analyses were used to assess the independent predictors. In univariate analysis, stent age ≥48 months (Odds ratio OR, 4.48; 95% CI 2.68-9.65; P<0.001), drug-eluting stents (OR, 2.66; 95% CI, 1.38-5.16; P=0.004), age ≥65 years (OR, 1.91; 95% CI, 1.05-3.44; P=0.032), current smoking (OR, 2.30; 95% CI, 1.10-4.82; P=0.024), chronic kidney disease (OR, 4.17; 95% CI, 1.42-12.23; P=0.009), and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockade use (OR, 0.42; 95% CI, 0.22-0.80; P=0.008) were significant predictors. In multivariate analysis, stent age ≥48 months, all subtypes of drug-eluting stent, current smoking, chronic kidney disease, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockade use remained independent predictors for NA. CONCLUSIONS: In addition to the stent type and the stent age, patient characteristics, including current smoking, chronic kidney disease, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockade, were associated with the presence of NA. This result may support the importance of secondary prevention after stent implantation.
Yonetsu et al. (Sat,) conducted a observational in Previous stent implantation with neointimal thickening (n=151). Risk factors (stent age, stent type, smoking, CKD, ACEI/ARB use) vs. Absence of risk factors was evaluated on Presence of neoatherosclerosis (lipid-laden neointima or calcification inside the stents) (OR 4.48, 95% CI 2.68-9.65, p=<0.001). Stent age ≥48 months (OR 4.48; 95% CI 2.68-9.65), drug-eluting stents, smoking, and chronic kidney disease independently predicted neoatherosclerosis, whereas ACEI/ARB use was protective.