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

Naotaka Akutsu, Koichiro Hori, Saki Mizobuchi, Akihito Ogaku, Yutaka Koyama, Hidesato Fujito, Riku Arai, Yasunari Ebuchi, Suguru Migita, Tomoyuki Morikawa, Takehiro Tamaki, Keisuke Kojima, Nobuhiro Murata, Toshihiko Nishida, Daisuke Kitano, Daisuke Fukamachi, Yasuo Okumura

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)536-550
Number of pages15
JournalJournal of Atherosclerosis and Thrombosis
Issue number4
Publication statusPublished - 2022


  • Coronary angioscopy
  • Everolimus-eluting stent
  • Low-Density Lipoprotein Cholesterol (LDL-C)/apolipoprotein B ratio
  • Neointimal grade
  • Neointimal volume
  • Optical coherence tomography
  • Yellow grade


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