Periprocedural myocardial injury according to optical characteristics of neointima and treatment modality of in-stent restenosis

Abstract

Aims Aim of the present study was to investigate the impact of increasing neointimal inhomogeneity and neoatherosclerosis as well as of treatment modality of in-stent restenosis (ISR) on the occurrence of periprocedural myocardial injury (PMI). Methods and results Patients with normal or stable/falling increased baseline high-sensitivity troponin T (hs-cTnT) undergoing intravascular optical coherence tomography (OCT) and subsequent percutaneous coronary intervention (PCI) of ISR by means of drug-coated balloon (DCB) or drug-eluting stent (DES) were included. Overall, 128 patients were subdivided into low (n = 64) and high (n = 64) inhomogeneity groups, based on the median of distribution of non-homogeneous quadrants. No significant between-group differences were detected in terms of hs-cTnT changes (28.0 [12.0–65.8] vs. 25.5 [9.8–65.0] ng/L; p = 0.355), or the incidence of major PMI (31.2 vs. 31.2%; p = 1.000). Similarly, no differences were observed between DCB- and DES-treated groups in terms of hs-cTn changes (27.0 [10.0–64.0] vs. 28.0 [11.0–73.0] ng/L; p = 0.795), or the incidence of major PMI (28.9 vs. 35.6%; p = 0.566). Additionally, no significant interaction was present between optical neointimal characteristics and treatment modality in terms of changes in hs-cTnT (Pint = 0.432). No significant differences in PMI occurrence were observed between low and high neoatherosclerosis subgroups. Conclusions In patients undergoing PCI for ISR, there was no association between increasing neointimal inhomogeneity, or increasing expression of neoatherosclerotic changes and occurrence of PMI. PMI occurrence was not influenced by the treatment modality (DCB vs. DES) of ISR lesions, a finding that supports the safety of DCB treatment for ISR. Graphical abstract

Association Between Periprocedural Myocardial Injury And Intra-intimal Microvessels：An Optical Coherence Tomography Study

“…In a patient-level pooled analysis, the incidence of PMI based on the de nition according to the 4th universal de nition of myocardial infarction was 52.8% [5]. A retrospective study [11] investigated the effect of increasing neointimal heterogeneity and neoatherosclerosis on the incidence of PMI. Their results showed that the incidence of hs-cTnT-based PMI was approximately 30%, which was similar to our nding (37.9%).…”

“…Studies on the association between neointimal characteristics and PMI occurrence after PCI for ISR has been extremely limited [11,20,21]. Lee et al [21] retrospectively analyzed the relationship between neointimal characteristics and the occurrence of PMI (de ned as creatine kinase-MB (CK-MB) > 99th percentile URL) in 125 patients with ISR lesions who underwent elective PCI and pre-PCI OCT examination.…”

“…In the multivariable logistic regression analysis, CAS-derived intensive yellow neointima was an independent predictor of PMI. Nano et al [11] investigated the relationships between neointimal characteristics and the PMI occurrence in 128 patients with ISR lesions by using OCT. However, the author reported no association between the neointimal characteristics and the occurrence of PMI.…”

“…Previous imaging studies have investigated the association between neointimal characteristics and PMI and found that thin-cap broatheroma (TCFA) or large necrotic cores and calcium had in uence on PMI [9,10]. Another imaging study explored the effect of tissue morphological characteristics of in-stent restenosis (ISR) on the incidence of PMI, indicated that neointimal heterogeneity, or neoatherosclerotic changes had no association with the occurrence of PMI [11].…”

Hypersensitivity and in-stent restenosis in coronary stent materials

“…Repeated DES implantation is the most effective treatment for ISR ( Giacoppo et al, 2015 ; Siontis et al, 2015 ); however, interventional procedures are subject to complications such as perioperative myocardial injury (PMI) ( Nano et al, 2022 ). In addition to the reopening of diseased blood vessels, drug therapy for allergic inflammation is worthy of further study.…”