Association between coronary atherosclerosis progression and in-stent neoatherosclerosis in patients with ST-elevation myocardial infarction at five-year follow-up

Aims: The aim of the study was to investigate the association between in-stent neoatherosclerosis (NA) and atherosclerosis progression (AP) in non-culprit segments in patients with ST-elevation myocardial infarction at live years. Methods and results: Sixty-two out of 169 consecutive patients included in the EXAMINATION study underwent optical coherence tomography (OCT) at five years. NA plaques were observed in 13 (21.0%), signal-rich bands (SRB) in 22 (35.5%) and AP in 11 (17.7%). NA plaques were more frequently observed in patients treated with two stents (53.8% vs. 20.4%; p=0.02). SRB were more frequently observed with longer stent length (29.8 +/- 11.6 vs. 22.51-9.1 mm; p<0.01), larger stent size (3.4 +/- 0.4 vs. 3.1 +/- 0.4 mm; p<0.01) and with bare metal stents (BMS) (68.2% vs. 40.0%; p=0.03). Patients with AP had higher levels of LDL-cholesterol (108.3 +/- 27.1 vs. 86.3 +/- 27.6 mg/dl; p=0.02). QCA of 744 non-culprit segments showed no association between NA plaques or SRB and reduction of lumen diameters. By multivariate analysis, NA plaques were associated with stent length; SRB were associated with stent length and BMS. AP was associated with mean LDL-cholesterol levels. Conclusions: NA and SRB had no association with AP or with LDL-cholesterol. NA and SRB were associated with stent-related factors such as stent length and BMS. AP was associated with LDL-cholesterol levels.