Predictors and outcomes of neoatherosclerosis in patients with in-stent restenosis.

Nakamura, Daisuke; Dohi, Tomoharu; Ishihara, Takayuki; Kikuchi, Atsushi; Mori, Naoki; Yokoi, Kensuke; Shiraki, Tatsuya; Mizote, Isamu; Mano, Toshiaki; Higuchi, Yoshiharu; Yamada, Takahisa; Nishino, Masami; Sakata, Yasushi

AIMS The purpose of this study was to investigate the impact of neoatherosclerosis on the prognosis after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR). METHODS AND RESULTS Between March 2009 and December 2017, 313 ISR lesions in patients undergoing an OCT guided PCI in five hospitals were retrospectively enrolled. Neoatherosclerosis was defined as a lipid neointima or calcified neointima. We examined the association between neoatherosclerosis and the clinical driven (CD-TLR) rates. In 313 ISR lesions, 64 lesions (20.4%) had bare metal stents and 241 lesions (77.0%) had drug eluting stents (DES). Among them, 47.0% of lesions (147 lesions) had neoatherosclerosis. A multivariate logistic regression analysis demonstrated that eGFR (odds ratio (OR), 0.986; 95% confidence interval (CI), 0.974-0.998; P=0.023), the time from the PCI to the ISR (OR, 1.13; 95% CI, 1.06-1.22; P<0.001) and DES-ISR (OR, 2.48; 95% CI, 1.18-5.43; P=0.019 ) were independent predictors with neoatherosclerosis. A multivariate regression analysis demonstrated that neoatherosclerosis was an independent predictor of CD-TLR. CONCLUSIONS In the multicenter ISR registry, OCT imaging demonstrated that eGFR, the time from the PCI to the ISR and DES-ISR were independent predictors for neoatherosclerosis and neoatherosclerosis in ISR lesions had a worse impact on the CD-TLR.