Background:Clinical and morphological factors associated with lipidic versus calcified neoatherosclerosis within second-generation drug-eluting stents and the impact of lipidic versus calcified neoatherosclerosis on long-term outcomes after repeat intervention have not been well studied.Methods:A total of 512 patients undergoing optical coherence tomography before percutaneous coronary intervention for second-generation drug-eluting stents in-stent restenosis were included. Neoatherosclerosis was defined as lipidic or calcified neointimal hyperplasia in ≥3 consecutive frames or ruptured lipidic neointimal hyperplasia. The primary outcome was target lesion failure (cardiac death, target vessel myocardial infarction, definite stent thrombosis, or clinically driven target lesion revascularization).Results:The overall prevalence of neoatherosclerosis was 28.5% (146/512): 56.8% lipidic, 30.8% calcified, and 12.3% both lipidic and calcific. The prevalence increased as a function of time from stent implantation: 20% at 1 to 3 years, 30% at 3 to 7 years, and 75% >7 years. Renal insufficiency, poor lipid profile, and time from stent implantation were associated with lipidic neoatherosclerosis, whereas severe renal insufficiency, female sex, and time from stent implantation were associated with calcified neoatherosclerosis. Multivariable Cox regression revealed that female sex and lipidic neoatherosclerosis were associated with more target lesion failure, whereas stent age and final minimum lumen diameter after reintervention were related to lower target lesion failure. Calcified neoatherosclerosis was not related to adverse events after reintervention for in-stent restenosis given a large enough minimum lumen diameter was achieved.Conclusions:Lipidic but not calcified neoatherosclerosis was associated with poor subsequent outcomes after repeat revascularization if optimal stent expansion was achieved in lesions with calcified neoatherosclerosis.

中文翻译：

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新生动脉粥样硬化对二代药物洗脱支架再狭窄经皮治疗后临床结局的患病率和影响

背景：与第二代药物洗脱支架内脂质与钙化新动脉粥样硬化相关的临床和形态学因素以及脂质与钙化新动脉粥样硬化对重复干预后长期结果的影响尚未得到很好的研究。方法：共有 512 例接受纳入第二代药物洗脱支架支架内再狭窄经皮冠状动脉介入治疗前的光学相干断层扫描。新动脉粥样硬化定义为≥3个连续帧中的脂质或钙化新内膜增生或脂质新内膜增生破裂。主要结果是靶病变失败（心源性死亡、靶血管心肌梗死、明确的支架血栓形成或临床驱动的靶病变血运重建）。结果：新动脉粥样硬化的总体患病率为 28.5% (146/512)：56.8% 为脂质，30.8% 为钙化，12.3% 为脂质和钙化。支架植入后患病率随时间增加：1 至 3 年为 20%，3 至 7 年为 30%，75%>7 年。肾功能不全、血脂差和支架植入时间与脂质性新动脉粥样硬化相关，而严重肾功能不全、女性和支架植入时间与钙化新动脉粥样硬化相关。多变量 Cox 回归显示，女性和脂质性新生动脉粥样硬化与更多的靶病变失败相关，而支架年龄和再介入后的最终最小管腔直径与较低的靶病变失败相关。