Relation Among HDL Functionality, Neoatherosclerosis and Target Lesion Revascularization
Condition: Coronary Artery Disease Progression
MeSH terms: Coronary Artery Disease; Erythema Multiforme; Disease Progression
Study type: Observational

Summary: 
      The aim of this study is to evaluate the relation among cholesterol uptake capacity which
      measure HDL functionality, neoathrosclerosis and target-lesion revascularization.
    

Detailed description: 
      Intracoronary stent implantation has markedly reduced the incidence of restenosis in patients
      with coronary artery disease. However, in-stent restenosis requiring target-lesion
      revascularization (TLR) occurs even with the use of drug-eluting stents. Emerging evidence
      suggests that among various potential risk factors, atherogenic progression within the
      neointima, "neoatherosclerosis" is one of the major contributors to TLR, and that patients'
      lipid profile is one of the key risk factors for the development of neoatherosclerosis.

      Conversely, recent animal and human studies have demonstrated the importance of high-density
      lipoprotein (HDL) functionality, rather than of HDL-cholesterol levels, in the development of
      de novo coronary artery disease. Cholesterol efflux capacity, a measure of the ability of HDL
      to promote cholesterol removal from lipid-laden macrophages, was found to be inversely
      correlated with the incidence of cardiovascular events and was shown to improve
      cardiovascular risk prediction beyond that with the use of traditional coronary risk factors.
      Therefore, the investigators hypothesized that the HDL function of promoting cholesterol
      removal from lipid-laden macrophages could be associated with TLR through its effect on the
      process of neoatherosclerosis progression within stents.

      Recently, the investigators developed a rapid cell-free assay system to directly evaluate the
      capacity of HDL to accept additional cholesterol; the measurement of this cholesterol uptake
      capacity (CUC) enables HDL functionality to be readily evaluated in our daily practice. Thus,
      the investigators performed this study in order to clarify the potential relationship among
      CUC, neoatherosclerosis, and TLR by using the novel cell-free assay system, CUC measurement,
      and optical coherence tomography (OCT) analysis.
    

Intervention name(s): neoatherosclerosis
Intervention type(s): Other
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        This study population consist of the consecutive patients who have undergone
        coronary-artery OCT. the investigators performed OCT for these reasons: (1) planned
        follow-up coronary angiography and OCT as routine stent follow-up or due to other study
        protocols, regardless of symptoms; (2) evidence of myocardial ischemia, such as silent
        myocardial ischemia, stable angina, or acute coronary syndrome; or (3) planned follow-up
        angiography for other stent segments. Exclusion criteria for OCT were (1) anatomically
        unsuitable target artery for OCT, according to previously described criteria; (2) apparent
        congestive heart failure; (3) renal insufficiency with baseline creatinine level of ≥2.0
        mg/dL except for under hemodialysis; or (4) no written informed consent from the patient.
      
Keywords: Neoatherosclerosis; Cholesterol Uptake Capacity