ABSTRACT
Objective To investigate the factors related to the occurrence of in-stent restenosis (ISR) after percutaneous coronary drug-eluting stent (DES) implantation. Methods A total of 258 consecutive patients with coronary angiography confirmed ISR that occurred at least one year after coronary sirolimus-eluting stent implantation, who were encountered at the Affiliated Ruijin Hospital of Shanghai Jiaotong University during the period from September 2010 to September 2014 , were collected as ISR group; and other 260 age-and sex-matched patients with no ISR at least one year after coronary sirolimus-eluting stent implantation, who were encountered at the same hospital and during the same period, were collected as the control group. The clinical characteristics, biochemical measurements, postoperative medications, left ventricular ejection fraction (LVEF), and coronary interventional features were determined;using multivariate logistic regression analysis the independent factors related to the occurrence of ISR were evaluated. Results Compared to the control group, in ISR group the history of previous myocardial infarction , presence of diabetes mellitus and cigarette smokers were more often seen; serum levels of high-sensitivity C-reactive protein(hs-CRP), glycosylated hemoglobin, low-density lipoprotein cholesterol (LDL-C)and apoliprotein B in ISR group were significantly increased (P<0.05), while LVEF was decreased (P<0.05). Although the number of coronary lesions and the site of stent implantation were quite similar in both groups , the stents used in ISR group were smaller and longer (P<0.05), and bifurcation stenting procedure was more employed in ISR group (P<0.05). Multivariate Logistic regression analysis revealed that the history of previous myocardial infarction, diabetes, cigarette smoking, elevated serum hs-CRP and LDL-C levels, and longer stent length were independent risk factors for the occurrence of ISR, whereas stent diameter and LVEF bore a negative correlation with ISR. Conclusion The occurrence of ISR after coronary sirolimus-eluting stent implantation is related to multiple clinical and coronary angiographic and interventional factors. Effective control of risk factors of coronary heart disease and improvement of left ventricular function play an important role in preventing ISR, especially for the patients who has small vessel disease, and in whom longer stents are employed and bifurcation stenting procedure is carried out.