Abstract 16865: Angioscopic and Serum Stent-Nonspecific Determinants of in-Stent Thrombosis After Drug-Eluting Stent Implantation
Background: Drug-eluting stents (DES) are susceptible to late thrombosis due to delayed re-endothelialization over the stent struts. Coronary angioscopy can semi-quantitatively visualize the presence of neointima coverage and thrombus. Although C-reactive protein (CRP) and oxidants have been proved as a useful biomarker for predicting atherothrombosis, the relationship between such biomarkers and in-stent thrombosis (IST) after drug-eluting stent implantation has not been defined. Aim: We examined angioscopic findings of neointima coverage and IST after DES (Sirolimus-eluting stent (SES) and Paclitaxiel-eluting stent (PES)) implantation compared to changes in CRP and oxidative stress.
Methods: For 8 to 14 month (11.8 month average) follow-up, a total of 138 (stent segments: 58 SES , 80 PES) in 72 DES patients were imaged with angioscopy. The prevalence of red thrombus, the angioscopic yellow grade of neointima, and the grade and its heterogeneity (coefficient of variance) of neointima coverage were examined by angioscopy In addition, the hydroperoxide reaction material measured by FRAS4 in coronary artery and serum CRP level were compared to the angiographic findings.
Results: The overall prevalence of angioscopic IST was 25.4 % during the total observation period. The prevalence was significantly higher in patients with PES (32.1%) than those with SES (21.7%: p=0.032). Neointima coverage grade and its heterogeneity were significantly higher in patients with in-stent red thrombus (IST patients) than those of non-IST patients(1.7±0.6, 1.2±0.3, respectively), while neointima yellow grade was significantly lower in IST patients than that in non-IST patients. The level of CRP were significantly increased in IST patients than that in non-IST patients(CRP:0.33±0.23 vs. 0.17±0.16 mg/dl, p=0.034). The patients with lower grades of neointima coverage (grade 0,1) had a significantly lager oxidative stress than in patients with higher grades (grade 2,3) of neointima (FRAS4: 407.6±88.9, 329.5±78.6 CAAR U, p=0.035).
Conclusions: These results suggested that the degree of neointima coverage and its heterogeneity as well as the degree of inflammation and oxidative stress might be related to in-stent red thrombus in patients with DES implantation.
- © 2010 by American Heart Association, Inc.