Analysis of related factors of neoatherosclerosis after coronary stent implantation by optical coherence tomography / 中国介入心脏病学杂志

ABSTRACT

Objective To evaluate the risk factors of neoatherosclerosis after coronary stent implantation through the study of optical coherence tomography (OCT) observation, and the effect of statin lipid-lowering therapy. Methods The clinical data of 40 patients with coronary heart disease (CHD) after coronary stent implantation (OCT) in Peking University First Hospital from June 2013 to June 2016 were analyzed retrospectively. The patients were divided into the target-achieved group (19 cases, LDL-C<1.8 mmol/L) and the above-target group (21 cases LDL-C ≥ 1.8 mmol/L) according to whether their low density lipoprotein (LDL) levels reached the treatment target. The medical history, biochemical parameters, medication and the qualitative and quantitative analysis of the neoatherosclerosis in the two groups were reviewed and compared. Results There were no statistical differences between the two groups in age, sex, smoking, comorbidities of hypertension, diabetes mellitus, kidney disease, history of myocardial infarction and time of stent implantation. Patients in the above-target group had higher LDL-C levels[(2.42 ± 0.79)mmol/L vs.(1.30 ± 0.35)mmol/L,P<0.001],higher cholesterol levels[(4.38 ±1.01)mmol/L vs.(3.07± 0.87)mmol/L,P<0.001], but lower statin used dosage[(15.26 ±2.30)mg/d vs.(22.38 ± 2.10)mg/d,P=0.032]as compared to patients in the target-achieved group. There was no statistical difference between the other parameter and medication profile. Qualitative analysis showed higher rates of neoatherosclerosis in the above-target group as compared to the target-achieved group(78.9% vs.38.1%,P=0.009),plus higher rates of endothelial heterogeneity(78.9% vs.38.1%,P=0.009),lipid plaque(73.7% vs.38.1%,P=0.024) and calcified plaque(26.3% vs. 4.8%,P=0.049). The rate of neointima restenosis in the above-target group was higher than that of the target-achieved group[(25.12 ±1.10)% vs.(19.70±1.10)%, P=0.001]. Logistic analysis showed that the level of low density lipoprotein(P=0.009),dosage of statin prescribed (P=0.040), male gender (P=0.042) and serum creatinine (P=0.012) were associated with the present of neonatal arteriosclerosis .Multivariate regression analysis showed levels of lipoprotein and low presence of statin dosage were the independent wish factors. Low density lipoprotein levels were positively correlated with neoatherosclerosis formation and the dosage of statin was negatively correlated (P<0.05).Conclusions In-stent restenosis after PCI is closely related to neonatal atherosclerosis. Controlling LDL-C to target levels can significantly reduce the risk of neoatherosclerosis. Intensified statin therapy strategy can prevent neoatherosclerosis in by certain extent.