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. 2022 Jul;111(7):827-837.
doi: 10.1007/s00392-022-02024-z. Epub 2022 Apr 27.

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

Nejva Nano  1 , Alp Aytekin  1 , Gjin Ndrepepa  1 , Masaru Seguchi  1 , Jola Bresha  2 , Hector Alfonso Alvarez Covarrubias  1 , Philipp Nicol  1 , Tobias Lenz  1 , Shqipdona Lahu  1 , Senta Gewalt, Felix Voll  1 , Tobias Rheude  1 , Jens Wiebe  1 , Heribert Schunkert  1   3 , Sebastian Kufner  1 , Salvatore Cassese  1 , Michael Joner  1   3 , Adnan Kastrati  1   3 , Erion Xhepa  4
Affiliations

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

Nejva Nano et al. Clin Res Cardiol. 2022 Jul.

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.

Keywords: Drug-eluting balloon; Drug-eluting stent; In-stent restenosis; Neointimal characterization; Optical coherence tomography; Periprocedural myocardial injury.

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Conflict of interest statement

No conflicts of interest related to the present work.

Figures

Fig. 1
Fig. 1
Images of optical coherence tomography findings in patients presenting with in-stent restenosis. A Homogeneous neointimal pattern. B Heterogeneous neointimal pattern. C Neoatherosclerosis with macrophage infiltration involving a 180° neointimal arc (arrows). D Neointimal calcification (arrow) * = guidewire artifact
Fig. 2
Fig. 2
Cumulative frequency distribution curves for baseline A, peak post-procedural B and delta C high-sensitivity cardiac Troponin T concentration
Fig. 3
Fig. 3
Cumulative frequency distribution curves for baseline (A), peak post-procedural B and delta C creatine kinase-MB concentration
Fig. 4
Fig. 4
Two-year cumulative incidence of major adverse cardiac events according to neointimal tissue characterization CI confidence interval, HR hazard ratio, MACE major adverse cardiac events
Fig. 5
Fig. 5
Two-year cumulative incidence of death or myocardial infarction according to neointimal tissue characterization CI confidence interval, HR hazard ratio, MI myocardial infarction
Fig. 6
Fig. 6
Two-year cumulative incidence of target-lesion revascularization according to neointimal tissue characterization CI confidence interval, HR hazard ratio, TLR target-lesion revascularization
See this image and copyright information in PMC

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