| Background: Percutaneous coronary intervention (PCI) is now widely used in thetreatment of coronary artery disease.With the revolutionary use of drug-eluting stents(DES), the in-stent restenosis is greatly reduced. However, the DES have the increasedrisks of inflammatory reactions and late in-stent thrombosis due to the persistenceinhibition of endotheliallization by drug coatings and polymer. Optical coherencetomography(OCT) is the most advanced technique in detecting intravascular lesions,widely used in detecting vulnerable plaques, intimal coverage, apposition of the struts andthrombosis. Studies have documented that the clinical outcome of patients with acutecoronary syndrome(ACS) and diabetes mellitus(DM) is still poor. However the clinicalsignificance of optical coherence tomography (OCT) measurements in ACS and DMpatients remains largely unknown because these patients have often been excluded in therandomized clinical trials.Methods and Results: The current study enrolled81patients (23stable angina,16acutemyocardial infarction and42unstable angina) between March2011and July2012. Allpatients underwent repeat coronary angiography with OCT imaging at1-2year follow-up.Despite similar angiographic in-stent restenosis, the OCT-detected mean neointimalhyperplasia（NIH） thickness（121.6±135.7mm vs.66.8±20.7mm, P=0.022）, percentageof NIH volume(11.88±8.22%vs.5.66±3.18%, P=0.012), percentage of cross-section withNIH thickness over100μm（40.14±30.01%vs.22.56±23.99%, P=0.034） and percentage of strut coverage（93.42±7.03%vs.89.27±6.40%, P=0.016） were lower in acutemyocardial infarction group. Multiple regression identified ACS and lipid rich plaque asrisk factors of uncovered struts.The current study had34DM and47non-DM patients. Compared with non-DMpatients, OCT revealed that DM patients have higher occurrence of new coronarylesions(71.45%vs.25.9%, P＜0.001). INH and incomplete stent apposition(ISA) weresimilar between two groups. Minimal lumen area lipid arc （157.91±119.72°vs.88.3±63.48°，P=0.050）, maximal calcific arc（22.36±33.22%vs.9.89±20.21%，P=0.001）and microvessl（7.1%vs.1.9%，P=0.039）were higher in DM group. Regression analysisidentified DM as the risk factor of fibrocalcified plaques。Subsequenty, we studied the correlation between progression of the non-stentsegment and the vessel healing of the stented segment. There were29patients withoutprogression and52patients with progression(19with new lesion of30%-50%,33withnew lesion of over50%). OCT results indicated that NIH and incomplete stentapposition(ISA) were similar between three groups. The uncovered ISA strutspercentage was higher in50%lesion group over normal（2.24±7.72%vs.11.25±18.24%vs.10.21±23.74%， P=0.037）, and the calcified plaque ratio （15.63±43.49%vs.12.60±19.76%vs.27.82±40.00%，P=0.05）was higer in patients with lesion over50%.Regression analysis identified DM and CRP as the risk factor of new lesions and lipid richplaque, ISA volume percentage, calcified plaque as the risk factor of uncovered ISA struts.Conclusions: In ACS patients undergoing DES-based PCI, NIH and coverage of thestruts were significantly lower than the stable angina group. DM was risk factor of lesionprogression. DM patients had higher calcification and neovascularization. Multipleregression analysis identified lipid rich plaque, ISA volume percentage, calcified plaque asthe risk factor of uncovered ISA struts.We would advise prolonging the antiplateleteduration for ACS patients and integrated treatment for DM patients to reduce theoccurrence of new lesions. |
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