Vascular remodeling after everolimus-eluting stent implantation in non-ST segment elevation acute coronary syndrome: optical coherence tomography

Highlights. Vascular healing response after stenting depends on both, procedure- and patient-related factors. The patient's age, lipid metabolism, the presence of heart failure, myocardial infarction, and the thickness of epicardial adipose tissue affect vascular remodeling after everolimus-eluting stent implantation.

Aim. To identify factors affecting vascular healing response after everolimus-eluting stent implantation in patients with non-ST segment elevation acute coronary syndrome.

Methods. 45 patients with non-ST segment elevation acute coronary syndrome who underwent everolimus-eluting stent implantation were included in a study. Stenting was performed without intravascular imaging guidance. All patients underwent repeated coronary angiography and optical coherence tomography of the stented segment 6 (±2) months after the indexed procedure. 39,860 struts in 4,576 sections were analyzed. The number of uncovered and malapposed struts was estimated, and the healing score was calculated. Cardiovascular death, repeated myocardial infarction, and repeated revascularization of the stented segment 12 months after the stenting were evaluated as a combined endpoint.

Results. 5 patients out of 45 reached the endpoint (11.1%), the main component of which was repeated revascularization. Patients who reached the endpoint had a lower healing score (4.5±2.6 and 19.9±17.9, respectively; p = 0.038). The healing score was lower in men (13.7±14.7 and 26.0±20.0, respectively; p = 0.041), those who had myocardial infarction at the time of stenting (5.5±6.7 for myocardial infarction and 19.8±17.9 for unstable angina, p = 0.045), and those who did not have heart failure (12.2±12.4 and 36.7±19.0, respectively; p = 0.0006). The healing score depended on the severity of the coronary lesion (24.8±19.4 for multivessel lesions, 10.0±8.7 for single-vessel lesions, and 7.3±6.3 for two-vessel lesions, respectively; p = 0.019). The linear regression reported the correlation of the healing score with age, atherogenicity coefficient, and the presence of chronic heart failure. The modified healing score depended on the epicardial fat thickness, atherogenicity coefficient, and blood urea level.

Conclusion. The nature and degree of vascular remodeling after everolimus-eluting stent implantation depends on the patient's age, diagnosis, heart failure, lipid metabolism, and the severity of the coronary lesion. The evaluation of vascular healing response may influence the decision on the duration of dual antiplatelet therapy

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