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Yellow plaque appears linked to very late stent failure
The presence of yellow plaque at 1 year after implantation with a drug-eluting stent was associated with a fivefold increase in the risk for very late stent failure, according to results of the DESNOTE study.
Researchers evaluated a cohort of 360 consecutive patients who underwent successful angioscopic examination 1 year after receiving a drug-eluting stent at a single facility. Patients were followed for incidence of very late stent failure for a mean of 4.3 years. Failure was defined as cardiac mortality, acute MI, unstable angina or the need for revascularization at the site of stent implantation.
Yellow plaque was identified in 65% of the cohort. The incidence rate of very late stent failure was 8.1% among patients with yellow plaque at 1 year compared with 1.6% among those without plaque (P = .02). Target lesion revascularization was significantly more common among those with yellow plaque, while cardiac death, acute MI and unstable angina were not, the researchers wrote.
Yellow plaque persisted as a risk factor for very late stent failure in multivariable analysis (HR = 5.38; 95% CI, 1.24-23.3). Absence of statin use (HR = 3.25; 95% CI, 1.18-8.92) also increased the risk for very late stent failure. Other factors associated with the primary endpoint included smaller stent diameter (HR = 0.27; 95% CI, 0.08-0.9) and serum LDL (HR = 0.97; 95% CI, 0.96-0.99).
The researchers calculated a sensitivity of 90.5% for the presence of yellow plaque for predicting the primary outcome, as well as a specificity of 36.3% and a negative predictive value of 98.4%.
“In-stent atherosclerosis evaluated by the presence of yellow plaque at 1 year after the implantation of DES and the absence of statin therapy was demonstrated as a risk of [very late stent failure],” the researchers concluded. “A main mechanism of [very late stent failure] was suggested to be the progression of atherosclerosis as shown by yellow plaque.” – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.