Abstract Objectives We aimed to evaluate the mid‐term outcomes of resolute zotarolimus‐eluting stent (R‐ZES) implantation for in‐stent restenosis (ISR). Background There has been a paucity of data regarding the effects of new‐generation drug‐eluting stent to treat ISR. Methods From 2009 to 2010, a total of 98 patients with 98 ISR lesions were prospectively enrolled after R‐ZES implantation for the treatment of ISR. Among 98 patients, 73 patients underwent follow‐up angiography at 9 months. Serial intravascular ultrasound (IVUS) at both postprocedure and 9 months was evaluated in 55 patients. The overlapped segment of R‐ZES was defined as the portion of R‐ZES superimposed on previous stent. Results Late loss and binary restenosis rate were 0.3 ± 0.5 mm and 5.5% at 9 months. On IVUS, the percentage of neointimal volume and maximum percentage of neointimal area were 3.9 ± 6.3% and 17.3 ± 15.5%, respectively. There was no significant change of vessel volume index between postprocedure and 9 months (16.9 ± 4.7 mm 3 /mm vs. 17.1 ± 4.6 mm 3 /mm, P = 0.251). Late‐acquired incomplete stent apposition was observed in 5 (5/55, 9.1%) cases. Compared with nonoverlapped segments of R‐ZES, the overlapped did not show larger neointimal volume index (0.3 ± 0.5 mm 3 /mm vs. 0.2 ± 0.3 mm 3 /mm, P = 0.187) on 9‐month IVUS. During follow‐up (median, 353 days), repeat target‐lesion revascularization was performed in four cases, but there were no death or stent thrombosis. Conclusions This study suggested that R‐ZES implantation for the treatment of ISR was effective up to 9 months and showed favorable vascular responses on serial IVUS assessment.
Introduction: The assessment of fractional flow reserve (FFR) in coronary lesions determines the strategy of percutaneous coronary intervention. However, the association between FFR and characteristics of underlying coronary plaque has not been sufficiently investigated. Methods: A total of 110 coronary lesions in 106 patients were evaluated using both FFR and optical coherence tomography (OCT). Coronary plaque was classified into fibrous, fibrocalcific, or fibroatheroma according to OCT evaluation at the site of minimal lumen area. Plaque microstructures such as cap thickness, macrophage accumulation, intimal vasculature, or cholesterol crystal were also evaluated. Results: Compared to lesions with FFR >0.8, those with FFR ≤0.8 showed a higher frequency of fibroatheroma, macrophage accumulation, and cholesterol crystal. However, multiple linear regression analysis revealed that any morphological characteristics of plaques assessed by OCT were not independently associated with FFR. Minimal lumen area (coefficient, 0.036; 95% confidence interval [CI], 0.022-0.049; p<0.001) and area stenosis (coefficient, - 0.003; 95% CI, -0.005--0.001; p<0.001) assessed by OCT significantly correlated with FFR. Thin-cap fibroatheroma was identified in 12 (10.9%) of all 110 lesions. There were no significant differences of minimal lumen area, area stenosis, or FFR between lesions with and without thin-cap fibroatheroma. Conclusions: Morphological characteristics of coronary plaque are not directly related to FFR. Conversely, the extent of functional or anatomical stenosis cannot identify the lesion with thin-cap fibroatheroma.
Background— Despite the enhanced properties of the second-generation drug-eluting stent (DES), its association with neoatherosclerosis has not been sufficiently evaluated. Therefore, we sought to evaluate and compare neoatherosclerosis in second-generation DESs to first-generation DESs. Methods and Results— A total of 212 DES-treated patients with >50% percent neointimal cross-sectional area stenosis were retrospectively enrolled from the Korean multicenter optical coherence tomography (OCT) registry. Within this population, 111 patients had a second-generation DES (40 zotarolimus, 36 everolimus, and 35 biolimus) and 101 patients had a first-generation (65 sirolimus and 36 paclitaxel) DES. Neoatherosclerosis on OCT was defined as neointima formation with the presence of lipids or calcification. OCT-determined neoatherosclerosis was identified in 27.4% (58/212) of all DES-treated lesions. The frequency of neoatherosclerosis increased with the stent age. Stent age was shorter in the second-generation DES group (12.4 months versus 55.4 months, P <0.001), and neoatherosclerosis was less frequently observed in that group (10.8% versus 45.5%, P <0.001). However, after adjusting for cardiovascular risk factors, chronic kidney disease (odds ratio, 4.113; 95% confidence interval, 1.086–15.575; P =0.037), >70 mg/dL of low-density cholesterol at follow-up OCT (odds ratio, 2.532; 95% confidence interval, 1.054–6.084; P =0.038), and stent age (odds ratio, 1.710; 95% confidence interval, 1.403–2.084; P <0.001) were all independent predictors for neoatherosclerosis, whereas the type of DES (first- versus second-generation) was not. Patients with neoatherosclerosis showed a higher rate of acute coronary syndrome at follow-up OCT (19.0% versus 3.9%, respectively, P =0.001). Conclusions— The second-generation DES is not more protective against neoatherosclerosis compared with the first-generation DES.
Bioresorbable vascular scaffold (BRS) is an innovative device that provides structural support and drug release to prevent early recoil or restenosis, and then degrades into nontoxic compounds to avoid late complications related with metallic drug-eluting stents (DESs).BRS has several putative advantages.However, recent randomized trials and registry studies raised clinical concerns about the safety and efficacy of first generation BRS.In addition, the general guidance for the optimal practice with BRS has not been suggested due to limited long-term clinical data in Korea.To address the safety and efficacy of BRS, we reviewed the clinical evidence of BRS implantation, and suggested the appropriate criteria for patient and lesion selection, scaffold implantation technique, and management.
Potent antiplatelet therapy after primary percutaneous coronary intervention (PCI) has the potential to reduce infarct size.This study analyzed the association between on-treatment platelet reactivity and myocardial infarct size in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.In this single-center, retrospective study, 253 patients who underwent primary PCI for STEMI were divided into two groups according to platelet reactivity measurements (53 patients in the high platelet reactivity [HPR] group and 200 in the non-HPR group).Technetium Tc-99m tetrofosmin single-photon emission computed tomography (SPECT) was performed before hospital discharge.We measured the infarct size using SPECT imaging and serial cardiac biomarker levels, and compared the infarct sizes of each group.The patients with HPR were older (65.5±13.2 vs. 60.6±12.1 years, p=0.011) than the patients with non-HPR.On the other hand, the non-HPR group had a higher incidence of smoking (26.4% vs. 51.0%,p=0.001) than the HPR group.Infarct size was similar between the two groups (22.6±17.3% vs. 24.8±17.7%,p=0.416).Multivariate analysis revealed that onset to balloon time >240 min (odds ratio [OR]=1.92;95% confidence interval [CI]=1.08-3.40;p=0.025) and anterior infarction (OR=5.28;95% CI=3.05-9.14;p<0.001) were independent predictors of large (>22%) infarct size.HPR was not a predictor of infarct size assessed by SPECT.The two groups also showed analogous cumulative creatinine kinase-myocardial band and troponin T levels.In conclusion, compared to non-HPR, HPR showed no significant association with myocardial infarct size measured by SPECT imaging in early phase of MI.
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