Incidence, clinical presentation, and predictors of early neoatherosclerosis after drug-eluting stent implantation

Background Compared with bare-metal stents, neoatherosclerosis reportedly develops earlier and more frequently after drug-eluting stent (DES) implantation. This study evaluated the incidence, clinical presentation, and predictors of early neoatherosclerosis after DES implantation. Methods Neointimal characteristics were evaluated in 449 patients (482 lesions) who underwent follow-up optical coherence tomography <= 12 months after DES implantation (median 9.1 months) and displayed a mean neointimal thickness >100 mu m. Neoatherosclerosis was defined as neointima with the presence of lipid or calcification. Results Early neoatherosclerosis, defined as occurrence of neoatherosclerosis within 12 months after DES implantation, was observed in 31 lesions (6.4%). Compared with patients without early neoatherosclerosis, those with early neoatherosclerosis presented with a higher incidence of clinical symptoms (13% vs 57%, respectively; P<.001) and had undergone a higher frequency of target-lesion revascularization (9% vs 55%, respectively; P<.001) at the time of optical coherence tomography follow-up. Multivariate logistic regression analysis showed that independent predictors of early neoatherosclerosis were hypertension (odds ratio 3.20, 95% CI 1.32-7.78, P=.010) and pre-stent low-density lipoprotein cholesterol >= 130 mg/dL at the time of the index procedure (odds ratio 3.89, 95% CI, 1.62-9.36, P=.002). Conclusions Early neoatherosclerosis was detected in 6.4% of DES-treated lesions with neointimal thickness >100 mu m at a median of 9.1 months after DES implantation. The occurrence of early neoatherosclerosis was significantly associated with presentation of clinical symptoms. Independent predictors of early neoatherosclerosis were hypertension and high pre-stent low-density lipoprotein cholesterol at the time of the index procedure.