Optical Coherence Tomographic Observation of In-Stent Neoatherosclerosis in Lesions With More Than 50% Neointimal Area Stenosis After Second-Generation Drug-Eluting Stent Implantation

Abstract

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 P 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 P =0.001). Conclusions—: The second-generation DES is not more protective against neoatherosclerosis compared with the first-generation DES.