Study On The Evaluation Of New Atherosclerosis In Stent And Its Influencing Factors By OCT

Objective(s): The purpose of this study was to investigate the optical coherence tomography(OCT)findings of new atherosclerotic plaque(ISNA)in coronary heart disease patients after stent implantation and its influencing factors.Methods: This study retrospectively analyzed 71 patients with coronary artery disease who underwent Coronary Angiography(CAG)and Optical Coherence Tomography(OCT)examination in the Second Affiliated Hospital of Kunming Medical University from April 2019 to December 2022 after coronary artery stent implantation.According to the results of OCT,they were divided into two groups: one group had 42 patients,in which in-stent neoatherosclerosis(ISNA)was found;There were 29 patients in the other group,and no ISNA was found in the stent.ISNA is defined as the formation of new intima in the stent and rich in lipid or calcification.Results: 1.General data analysis showed that the platelet distribution width(15.05±3.19 vs 12.27±2.77,P<0.001),average platelet volume(11.31±1.47 vs 10.21±1.09,P<0.01),large platelet ratio(35.44 ± 10.92 vs 27.01 ± 8.72,P<0.01),stent implantation time 54.00(13.75114.00)vs 12.00(12.00,24.00),P<0.01,triglyceride1.68(1.12,3.03)vs 1.02(0.76,1.41),P<0.01,LDL-C2.03(1.60,2.53)vs 1.80(1.33,2.00),P<0.05,ISNA group was higher than non-ISNA group,while total bilirubin10.45(7.87,13.37)vs 13.10(9.05,16.70),P<0.05,ISNA group was lower than non-ISNA group.2.Quantitative analysis of OCT images showed that the minimum lumen area(2.16 ± 1.02 vs 3.52 ± 1.83,P<0.01)in ISNA group was smaller than that in non-ISNA group,while the maximum neointimal thickness(1.00±0.21 vs 0.47±0.20,P<0.01),neointimal area(5.05 ± 2.04 vs 2.23 ± 1.02,P<0.01),neointimal stenosis rate 0.71(0.63,0.79)vs 0.36(0.27,0.56),P<0.01,was higher than that in non-ISNA group.3.Qualitative analysis of OCT images showed that compared with non-ISNA group,the proportion of macrophage infiltration(64.3% vs 10.3%,P<0.01),microchannel(54.8% vs 27.6%,P<0.01),plaque rupture(21.4% vs 0.00%,P<0.01),TACF(26.2% vs 0.00%,P<0.01),red thrombus(28.6% vs 0.00%,P<0.01),white thrombus(47.6% vs 17.2%,P<0.01),and cholesterol crystal(76.2% vs 37.9%,P<0.01)increased in ISNA group.4.Through univariate binary Logistic regression analysis,the average volume of platelets(OR: 1.924,95% CI: 1.248-2.965,P<0.01),the ratio of large platelets(OR:1.090,95% CI: 1.031-1.153,P<0.01),the distribution width of platelets(OR: 1.409,95% CI: 1.139-1.743,P<0.01),the level of triglycerides(OR: 3.449,95% CI:1.535-7.750,P<0.01)The stent implantation time(OR: 1.031,95% CI: 1.012-1.050,P<0.01)was confirmed to be the influencing factor of ISNA.After multivariate Logistic correction,the stent implantation time(OR: 1.040,95% CI: 1.05-1.065,P<0.01)and the triglyceride level(OR: 5.858,95% CI: 1.701-20.180,P<0.01)were independently related to the occurrence of ISNA,while the platelet distribution width(OR: 1.493,95% CI: 1.098-2.030,P<0.05)was independent of the classical predictors of INSA(that is,stent implantation time,blood lipid level),and was still independently related to ISNA.5.The ROC curve showed that the cut-off value of platelet distribution width used to predict ISNA was 12.65%,the sensitivity was 0.833,and the specificity was0.655.[Area under curve(AUC): 0.741;95% CI: 0.619–0.864;P<0.01].According to the threshold of platelet distribution width calculated by Yoden index,the cohort was divided into two groups: the higher platelet distribution width group(≥12.65%,n=45)and the lower platelet distribution width group(<12.65%,n=26).Conclusion(s):1.The vascular lumen of ISNA is more prone to detecting vulnerable plaque features such as TACF,macrophage infiltration,and microchannels.The probability of plaque rupture is higher.The area,thickness,and stenosis rate of neointima in the vascular lumen of ISNA are higher than those of non ISNA.2.The occurrence of ISNA is related to platelet morphology and positively correlated with PDW,average platelet volume,and large platelet ratio.PDW has certain predictive value for the occurrence of ISNA.3.ISNA and traditional atherosclerosis have the same risk factors,such as hypertension,diabetes,and blood lipid levels.