Author + information
- Yuetsu Kikuta,
- Hideo Takebayashi,
- Shigeki Hiramatsu,
- Manabu Taniguchi,
- Kenji Goto,
- Masahito Taniguchi,
- Katsumasa Sato,
- Etsuko Ikeda,
- Arata Hagikura,
- Hiroki Yamane and
- Seiichi Haruta
Little is known about the effect of macrophage accumulations (Mp) on bare–metal stent (BMS) failure.
We evaluated 60 consecutive BMS failure lesions in 60 patients 15 acute coronary syndrome [ACS] and 45 stable angina pectoris [SAP], median stent duration 11.3 [interquartile range 7.6–47.8] months) by optical coherence tomography. Neointima with Mp was defined as thin bright layer with shadowing (peak intensity >180 and attenuation rate >2, when measurements were fitted to an approximate exponential function).
The mean age was 67.8 ± 9.7 years, 55 patients (91.7%) were male, and 21 (35.0%) were diabetic. Compared with SAP patients, ACS patients showed higher incidence of thin–cap fibroatheroma (TCFA)–containing neointima (53.3% versus 4.4%, p<0.0001), lesions with Mp (66.7% versus 8.9%, p<0.0001), neointimal rupture (60.0% versus 11.1%, p=0.0004), thrombus (66.7% versus 31.1%, p=0.031), and had higher admission LDL (110.3 ± 28.8 versus 89.3 ± 21.4 mg/dl, p=0.017) and higher LDL/HDL ratio (2.65 ± 0.86 versus 1.95 ± 0.65, p=0.009). Stent failure with TCFA–containing neointima (n=10) expressed higher incidence of Mp (100% versus 8.0%, p<0.0001), larger Mp angle (157.0 [range 89.5–261.8] versus 0 [0–0] °, p=0.0006), and longer Mp longitudinal length (9.5 [range 5.0–14] versus 0 [0–0] mm, p=0.0009) than non–TCFA–containing neointima (n=50). Compared with lesions without neointimal rupture (n=46), lesions with neointimal rupture (n=14) demonstrated higher incidence of Mp (78.6% versus 6.5%, p<0.0001), larger Mp angle (125.5 [range 24.0–261.8] versus 0 [0–0] °, p=0.0009), and longer Mp longitudinal length (7.5 [range 1.0–12.5] versus 0 [0–0] mm, p=0.001). Thrombotic stent failure lesions (n=24) showed more Mp (45.8% versus 8.3%, p=0.001) than non–thrombotic lesions (n=36). Fourteen stent failure patients with Mp presented later than 46 patients without Mp (p<0.0001). Using receiver–operating curve analysis, 16.7 months was the best predictor of the presence of Mp with a sensitivity of 100% and a specificity of 84.8% (area under curve =0.946, p<0.0001).
Mp might be associated with neoatherosclerosis and unstable features of BMS neointima.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Intravascular Imaging: IVUS and OCT
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2108–244
- 2013 American College of Cardiology Foundation