Risk Factors And Clinical Prognosis Of Neoatherosclerosis In Patients With In-stent Restenosis

Objective: In recent years,the prevalence of coronary heart disease has been increasing year by year and has become an important cause of health hazards to the lives of our people.Coronary artery stents have greatly relieved the symptoms of coronary heart disease patients,but the danger of neoatherosclerosis within the stent after stent implantation is gaining more and more attention.Neoatherosclerosis is the formation of atherosclerosis in the neointima of the stent.It has been found to be an important cause of in-stent restenosis or late/very late in-stent thrombosis.However,the incidence of de neoatherosclerosis in the coronary stenting population is still unclear and the risk factors for de neoatherosclerosis are more controversial.Therefore,the aim of this study was to determine the incidence of neoatherosclerosis in the coronary stenting population,to investigate the risk factors for neoatherosclerosis,to assess the clinical prognosis of the neoatherosclerotic population compared to the non-neoatherosclerotic population,and to improve the management of the coronary stenting population.Methods: Data on patients diagnosed with in-stent restenosis by coronary angiography from 1 January 2019 to 30 November 2022 were obtained from the case management system of the General Hospital of the Northern War Zone of the Chinese People’s Liberation Army,of which data on patients who underwent further optical coherence tomography were screened to collect cases that met the inclusion and exclusion criteria.Patients were divided into a group with in-stent neoatherosclerosis and a group without neoatherosclerosis.Neoatherosclerosis was defined as the presence of lipid-based neointima or calcified neointima.For patients in the neoatherosclerosis and nonneoatherosclerosis groups,differences between the different groups were compared using parametric or non-parametric methods for continuous or discrete variables(including qualitative and quantitative analyses related to clinical baseline presentation,interventional characteristics and optical tomography images).Logistic regression models were constructed to investigate the association of single and multiple factors with neoatherosclerosis.In addition,we investigated the association of neoatherosclerosis with cardiovascular events.The impact of neoatherosclerosis on cardiovascular events was studied using Kaplan-Meier,and the impact of factors such as neoatherosclerosis on clinical prognosis was assessed using multivariate Cox proportional risk regression models.Results: Of the 117 lesions in the 116 restenosis patients,100(85.5%)of the restenosis stents were drug-eluting stents and 17(14.5%)of the restenosis stents were non-drugeluting stents.Of these lesions,48.7%(57 lesions)were neoatherosclerotic.Multifactorial logistic regression analysis showed that time from stent implantation to in-stent restenosis(OR 1.009,95% CI: 1.001-1.016;p<0.025)was an independent predictor of lipid type of neoatherosclerosis;serum creatinine(OR 1.018,95% CI:(1.001-1.036);p=0.043 Kaplan-Meier analysis showed that the incidence of cardiovascular events was significantly higher in patients with neoatherosclerotic lesions than in patients without neoatherosclerosis(OR 1.019,95% CI: 1.010-1.028;p<0.001).(Multivariate analysis of the Cox proportional risk model showed that neoatherosclerosis was an independent predictor of cardiovascular events(HR 1.80,95%CI: 3.424-10.603,p=0.033).Conclusion: 1.In the in-stent restenosis population,approximately half of the lesions had neoatherosclerosis.2.Time from stent implantation to in-stent restenosis was an independent predictor of lipid type neoatherosclerosis;serum creatinine and time from stent implantation to in-stent restenosis were independent predictors of calcified type neoatherosclerosis.3.Multivariate analysis of the Cox proportional risk model The analysis showed that neoatherosclerosis was an independent predictor of cardiovascular events.