DES置入后5年以上支架内再狭窄新生内膜OCT分析

OCT analysis of in-stent neointima over 5 years post-DES implantation

目的基于光学相干断层成像(OCT)探讨药物洗脱支架(DES)置入后5年以上支架内再狭窄(ISR)患者的新生内膜增生(NIH)特性。方法本研究为横断面研究。连续入组2010年3月至2022年3月于解放军总医院接受OCT检查的DES-ISR患者。依据发现ISR距离DES置入时间,将入选患者分为支架置入时间≤5年组和支架置入时间>5年组。对OCT图像进行定量和定性分析,比较两组患者的临床资料及病变特征,并通过多因素logistic回归分析支架内新生动脉粥样硬化(ISNA)的临床独立相关因素。结果纳入DES-ISR患者230例,年龄(63.1±10.4)岁,男性188例(81.7%),包含249个病变。DES-ISR中位发现时间为6(2,9)年。支架置入时间≤5年组117例(ISR病变122个),支架置入时间>5年组113例(ISR病变127个)。与支架置入时间≤5年组相比,支架置入时间>5年组中异质性[65.4%(83/127)比48.4%(59/122),P=0.007]、弥漫性[46.5%(59/127)比31.2%(38/122),P=0.013]以及伴有巨噬细胞聚集[44.1%(56/127)比31.2%(38/122),P=0.035]的NIH更多见,且ISNA患病率更高[83.5%(106/127)比72.1%(88/122),P=0.031]。多因素logistic回归分析结果显示,ISNA的独立相关因素为女性(OR=0.44,95%CI 0.21~0.90,P=0.026),脂质型ISNA的独立相关因素包括女性(OR=0.48,95%CI 0.23~0.99,P=0.046)及低密度脂蛋白胆固醇水平(OR=1.62,95%CI 1.01~2.59,P=0.046),而钙化型ISNA与支架置入时间(OR=1.18,95%CI 1.07~1.29,P=0.001)独立相关。结论支架置入>5年的DES-ISR患者ISNA患病率更高且病变更复杂。性别、低密度脂蛋白胆固醇水平及支架置入时间与ISNA、脂质型ISNA及钙化型ISNA独立相关。

Objective To investigate the characteristics of neointimal hyperplasia(NIH)in patients with in-stent restenosis(ISR)over 5 years post-drug-eluting stent(DES)implantation based on optical coherence tomography(OCT).Methods In this cross-sectional study,patients with DES-ISR who underwent OCT examination at PLA General Hospital between March 2010 and March 2022 were retrospectively included.All patients were divided into≤5 years DES-ISR group and>5 years DES-ISR group according to the time interval after DES implantation.Quantitative and qualitative analyses were conducted on OCT images to compare the clinical data and lesion characteristics of two patient groups.Furthermore,the independent clinical predictive factors of in-stent neoatherosclerosis(ISNA)were analyzed by multivariable logistic regression.Results A total of 230 DES-ISR patients with 249 lesions were included,with an age of(63.1±10.4)years and 188 males(81.7%).The median interval after DES implantation was 6(2,9)years.There were 117 patients(122 ISR lesions)in the≤5 years DES-ISR group,and 113 patients(127 ISR lesions)in the>5 years DES-ISR group.Compared with≤5 years DES-ISR,>5 years DES-ISR showed more heterogeneous patterns(65.4%(83/127)vs.48.4%(59/122),P=0.007),diffuse patterns(46.5%(59/127)vs.31.2%(38/122),P=0.013),macrophage accumulations(44.1%(56/127)vs.31.2%(38/122),P=0.035)in NIH and higher prevalence of ISNA(83.5%(106/127)vs.72.1%(88/122),P=0.031).According to multivariable logistic regression,the independent predictive factor for ISNA was female(OR=0.44,95%CI 0.21-0.90,P=0.026).Female(OR=0.48,95%CI 0.23-0.99,P=0.046)and low-density lipoprotein cholesterol level(OR=1.62,95%CI 1.01-2.59,P=0.046)were independent predictive factors,respectively,for lipid ISNA.Calcified ISNA was independently associated with time interval of post-DES implantation(OR=1.18,95%CI 1.07-1.29,P=0.001).Conclusion DES-ISR patients with a time interval of>5 years after stent implantation have a higher prevalence of ISNA and more complex lesions.Gender,the level of low-density lipoprotein cholesterol,and the time interval post-DES implantation are independently correlated with ISNA,lipid ISNA,and calcified ISNA.