The impact of acute coronary syndrome on late drug-eluting stents restenosis: Insights from optical coherence tomography

Sijing Wu, Wei Liu, Yonghe Guo, Yaping Zeng, Zhiming Zhou, Yingxin Zhao, Yuyang Liu, Dongmei Shi, Zhijian Wang, Hailong Ge, Jianlong Wang, Peng Jin, Yujie Zhou, Sijing Wu, Wei Liu, Yonghe Guo, Yaping Zeng, Zhiming Zhou, Yingxin Zhao, Yuyang Liu, Dongmei Shi, Zhijian Wang, Hailong Ge, Jianlong Wang, Peng Jin, Yujie Zhou

Abstract

The aim of the study was to investigate the optical coherence tomography (OCT)-identified difference of in-stent restenosis (ISR) tissue characteristics between patients with and without acute coronary syndrome (ACS) at index intervention.The retrospective study included 80 patients with 85 drug-eluting stent (DES) restenosis lesions. Subjects were classified according to clinical presentation at the time of de-novo lesion intervention, namely ACS and non-ACS. OCT was performed at 5 years follow-up. The frequency of malapposition, neointimal characteristics, thrombus, and minimal stent area (MSA) were evaluated.ACS group consisted of 48 (60%) patients. The mean duration from initial intervention to OCT study was 66.15 months. Malapposition was more frequent in the ACS group (25.5% vs 2.9%, P = .006), as well as a higher prevalence of thrombus in the ACS group (21.6% vs 0%, P = .015). MSA of ACS group was significantly less than that of non-ACS group (4.99 ± 1.80 vs 5.62 ± 2.08 mm, P = .018). Compared with non-ACS group, only MI group was related to smaller MSA (4.37 ± 1.39 vs 5.62 ± 2.08 mm, P = .048); The unstable angina (UA) group was not associated with a decreased MSA. The occurrence of neoatherosclerosis tended to be higher in ACS group (60.8% vs 41.2%, P = .076).In DES restenosis, an ACS presentation at initial intervention is associated with a higher incidence of malapposition, thrombus, and smaller MSA.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Figures

Figure 1
Figure 1
Incidence of malapposition and thrombus according to initial clinical presentation. Percentage of lesions with malapposition and thrombus in MI group, UA group, and non-ACS group. ∗Indicates P < .01 compared with non-ACS group. ACS = acute coronary syndrome, MI = myocardial infarction, UA = unstable angina.
Figure 2
Figure 2
Comparison of minimal stent area according to initial clinical presentation. Values of minimal stent area in MI group, UA group, and non-ACS group. ACS = acute coronary syndrome, MI = myocardial infarction, UA = unstable angina.
Figure 3
Figure 3
DES restenosis lesion characteristics in patients initially treated for acute coronary syndrome. (A) Example of white thrombus associated with malapposition at restenosis lesion: DES placement for UA 60 months ago. Both OCT cross-section and longitudinal images (A2 and A3) of the restenosis lesion shows struts malapposition and coupled white thrombus. (B) Example of red thrombus at restenosis lesion: DES implantation for NSTEMI 72 months ago. An OCT cross-sectional image in the restenosis region (B2) shows red thrombus. The OCT longitudinal reconstruction (B3) demonstrates the thrombus is located at the lumen with extensive neointimal growth. DES = drug-eluting stent, OCT = optical coherence tomography, UA = unstable angina.

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Source: PubMed

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