• Seung-Yul Lee, Myeong-Ki Hong, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, and Yangsoo Jang.
• Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
• Catheter Cardiovasc Interv. 2015 Mar 1; 85 (4): 564-72.

ObjectivesWe evaluated whether morphological characteristics of neointimal tissue of in-stent restenosis (ISR) lesions assessed by optical coherence tomography (OCT) affect periprocedural elevation of creatine kinase-myocardial band (CK-MB).BackgroundThe impact of neointimal characteristics of ISR lesions on periprocedural myocardial injury has not been sufficiently investigated.MethodsA total of 125 patients with ISR lesions underwent elective percutaneous coronary intervention (PCI) and pre-PCI OCT examination. Measurements of CK-MB were performed upon hospitalization, before PCI, and every 8 hr for 24 hr after PCI. CK-MB elevation was defined as levels above the 99th percentile of the upper reference limit. Neoatherosclerosis was defined as neointima with lipid or calcification.ResultsPost-PCI CK-MB elevation was observed in 20 (16.0%) patients. The maximum length of consecutive cross-sections with neoatherosclerosis on the longitudinal axis of the stent was significantly larger in patients with post-PCI CK-MB elevation than in those without [8.8 mm (1.5-10.4) vs. 0.0 mm (0.0-1.0), P < 0.001], and thin-cap fibroatheroma (TCFA) were more frequently observed at the site of minimal lumen cross-sectional area in patients with post-PCI CK-MB elevation (55.0% vs. 1.9%, P < 0.001). Multivariate analysis revealed that the maximum length of segments with neoatherosclerosis [odds ratio (OR), 1.463; 95% confidence interval (CI), 1.090-1.962; P = 0.011] and TCFA (OR, 14.328; 95% CI, 1.118-183.628; P = 0.041) were independent predictors for post-PCI CK-MB elevation.ConclusionsA greater axial length of neoatherosclerosis and the presence of TCFA at the most stenotic site were significantly associated with post-PCI CK-MB elevation in ISR lesions.© 2014 Wiley Periodicals, Inc.

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