Atherogenesis in Native Coronary Segments and In-Stent Neoatherogenesis Beyond Three Years After First-Generation Drug-Eluting Stent Implantation: Angiographic and Optical Coherence Tomography Study.

ABSTRACT

OBJECTIVES: The mechanisms underlying the development of neoatherosclerosis following stent implantation remain to be further elucidated. The aim of this study was to investigate the association between subclinical in-stent neoatherosclerosis (NA) and atherosclerosis progression of native coronary segments in patients with chronic coronary syndrome 3 and 9 years after first-generation drug-eluting stent implantation. METHODS: This is a prespecified analysis of the prospective cohort study evaluating long-term neointimal healing in consecutive patients undergoing elective percutaneous coronary intervention with sirolimus-eluting stent (SES) or paclitaxel-eluting stent (PES) implantation. Quantitative coronary angiography (QCA) was evaluated in non-stented coronary segments. RESULTS: Forty-three patients underwent optical coherence tomography (OCT) and QCA at 3 years and 21 patients at 3 years and 9 years after SES or PES implantation. NA was identified in 44.2% at 3 years and in 66.7% at 9 years after the index procedure. NA at 3 years was more frequently observed in patients with atherosclerosis progression in native coronary segments than without (66.7% vs 15.8%; P<.01). Higher low-density cholesterol level (93 mg/dL vs 77 mg/dL; P=.04), greater maximal neointimal thickness (0.74 mm vs 0.37 mm; P<.001), and presence of peristrut low-intensity areas (57.9% vs 20.8%; P=.01) were more frequent in patients with NA. NA progression (P=.01) along with greater neointimal growth (P<.01) were detected in serial analysis between 3-year and 9-year OCT assessments. CONCLUSIONS: OCT-confirmed NA formation after first-generation drug-eluting stent implantation was associated with QCA-defined atherosclerosis progression in non-stented segments between 0 and 3 years. NA and neointimal proliferation continued between 3 and 9 years.