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Nano N, Aytekin A, Ndrepepa G, Seguchi M, Bresha J, Alvarez Covarrubias HA, Nicol P, Lenz T, Lahu S, Gewalt S, Voll F, Rheude T, Wiebe J, Schunkert H, Kufner S, Cassese S, Joner M, Kastrati A, Xhepa E. Periprocedural myocardial injury according to optical characteristics of neointima and treatment modality of in-stent restenosis. Clin Res Cardiol 2022; 111:827-837. [PMID: 35476138 PMCID: PMC9242953 DOI: 10.1007/s00392-022-02024-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
Aims Aim of the present study was to investigate the impact of increasing neointimal inhomogeneity and neoatherosclerosis as well as of treatment modality of in-stent restenosis (ISR) on the occurrence of periprocedural myocardial injury (PMI). Methods and results Patients with normal or stable/falling increased baseline high-sensitivity troponin T (hs-cTnT) undergoing intravascular optical coherence tomography (OCT) and subsequent percutaneous coronary intervention (PCI) of ISR by means of drug-coated balloon (DCB) or drug-eluting stent (DES) were included. Overall, 128 patients were subdivided into low (n = 64) and high (n = 64) inhomogeneity groups, based on the median of distribution of non-homogeneous quadrants. No significant between-group differences were detected in terms of hs-cTnT changes (28.0 [12.0–65.8] vs. 25.5 [9.8–65.0] ng/L; p = 0.355), or the incidence of major PMI (31.2 vs. 31.2%; p = 1.000). Similarly, no differences were observed between DCB- and DES-treated groups in terms of hs-cTn changes (27.0 [10.0–64.0] vs. 28.0 [11.0–73.0] ng/L; p = 0.795), or the incidence of major PMI (28.9 vs. 35.6%; p = 0.566). Additionally, no significant interaction was present between optical neointimal characteristics and treatment modality in terms of changes in hs-cTnT (Pint = 0.432). No significant differences in PMI occurrence were observed between low and high neoatherosclerosis subgroups. Conclusions In patients undergoing PCI for ISR, there was no association between increasing neointimal inhomogeneity, or increasing expression of neoatherosclerotic changes and occurrence of PMI. PMI occurrence was not influenced by the treatment modality (DCB vs. DES) of ISR lesions, a finding that supports the safety of DCB treatment for ISR. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02024-z.
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Affiliation(s)
- Nejva Nano
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Alp Aytekin
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Gjin Ndrepepa
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Masaru Seguchi
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Jola Bresha
- Medizinische Klinik Und Poliklinik Innere Medizin I, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Hector Alfonso Alvarez Covarrubias
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Philipp Nicol
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Tobias Lenz
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Shqipdona Lahu
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | | | - Felix Voll
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Tobias Rheude
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Jens Wiebe
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Heribert Schunkert
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sebastian Kufner
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Salvatore Cassese
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Michael Joner
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Erion Xhepa
- Klinik Für Herz- Und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
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