Predictors for the Early Development of Neoatherosclerosis After Newer-generation Drug-eluting Stent Implantation

An Optical Coherence Tomographic Study

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Objective: Several studies have described predictors for the late development of neoatherosclerosis (NA). However, predictors for the early development of NA after newer generation drug-eluting stent (DES) implantation are unknown. We investigated predictors for the eight-month development of NA using optical coherence tomography (OCT). Patients and methods: We enrolled 117 consecutive patients (134 lesions) with second- and third-generation DESs with findings available for baseline and 8-month follow-up OCT. The lesions were divided into two groups: those with and without NA at eight-month follow-up OCT. NA was defined as lipid neointima including a thin-cap fibroatheroma that was defined as fibroatheroma with fibrous cap of < 65 μm or calcified neointima. Results: NA was detected in 9.0% of all lesions at follow-up. A smoking history and irregular in-stent protrusions (IPs) at post-stent OCT were independent predictors of the eight-month development of NA. A receiver operating characteristic curve revealed that the predictive cut-off value of maximum IP for early development of NA was 80°. In a segmental analysis, the prevalence of segments with NA from segments with IPs was significantly higher than that from segments without IPs (4.2% vs. 0.8%, P < 0.001). Conclusions: IPs at post-stent OCT and a smoking history may be predictors of the eight-month development of NA after second- and third-generation DES implantation. On the serial comparison of OCT findings, early NA showed positional correlation with IPs on post-stent OCT.