Clinical Importance of the LDL-C/Apolipoprotein B Ratio for Neointimal Formation after Everolimus-Eluting Stent Implantations

• Published in: Journal of Atherosclerosis and Thrombosis 2022/04/01, Vol.29(4), pp.536-550
• Main Authors: Akutsu, Naotaka, Hori, Koichiro, Mizobuchi, Saki, Ogaku, Akihito, Koyama, Yutaka, Fujito, Hidesato, Arai, Riku, Ebuchi, Yasunari, Migita, Suguru, Morikawa, Tomoyuki, Tamaki, Takehiro, Kojima, Keisuke, Murata, Nobuhiro, Nishida, Toshihiko, Kitano, Daisuke, Fukamachi, Daisuke, Okumura, Yasuo
• Format: Article
• Language: English
• Subjects: Apolipoproteins; Apolipoproteins B; Cholesterol, LDL; Coronary Angiography; Coronary angioscopy; Coronary Artery Disease - etiology; Coronary Vessels - diagnostic imaging; Drug-Eluting Stents - adverse effects; Everolimus; Everolimus-eluting stent; Humans; Low-Density Lipoprotein Cholesterol (LDL-C)/apolipoprotein B ratio; Neointima; Neointimal grade; Neointimal volume; Optical coherence tomography; Original; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Tomography, Optical Coherence - methods; Yellow grade
• ISSN: 1340-3478; 1880-3873
• DOI: 10.5551/jat.60954

Aims: Smaller low-density lipoprotein (LDL) particle size has been suggested to result in the development of endothelial dysfunction, atherosclerosis, and in-stent restenosis (ISR); however, little is known regarding the impact of the LDL particle size on the neointima formation leading to ISR after everolimus-eluting stent (EES) implantation. Methods: In this study, we have included 100 patients to examine the relationship between an LDL-C/apolipoprotein B (Apo B) ≤ 1.2, reportedly representing the LDL particle size, and the neointimal characteristics using optical coherence tomography (OCT) and coronary angioscopy (CAS) during the follow-up coronary angiography (CAG) period (8.8±2.5 months) after EES implantation. We divided them into two groups: LDL-C/Apo B ≤ 1.2 group (low LDL-C/Apo B group, n=53) and LDL-C/Apo B ＞1.2 group (high LDL-C/Apo B group, n=47). Results: The low LDL-C/Apo B group had a significantly larger neointimal volume (12.8±5.3 vs. 10.3±4.9 mm3, p=0.021) and lower incidence of a neointimal homogeneous pattern (71 vs. 89 %), higher incidence of a neointimal heterogeneous pattern (25 vs. 9 %) (p=0.006) and higher prevalence of macrophage accumulation (9 vs. 2 %) (p=0.030) as assessed via OCT, and, as per the CAS findings, a higher prevalence of yellow grade ≥ 2 (grade 2; adjusted residual: 2.94, grade 3; adjusted residual: 2.00, p=0.017) than the high LDL-C/Apo B group. Conclusions: A low LDL-C/Apo B ratio was found to be strongly associated with neointimal proliferation and neointimal instability evidenced chronically by OCT and CAS. An LDL-C/Apo B ≤ 1.2 will be of aid in terms of identifying high-risk patients after EES implantation.