Investigation of the clinical predictors of in-stent restenosis after rapamycin-eluting coronary stent implantation / 介入放射学杂志

ABSTRACT

Objective To analyze the relationship of oxidized low density lipoprotein (ox-LDL) and homocysteine (Hcy) with coronary in-stent restenosis (ISR),and to discuss the clinical predictors of ISR after rapamycin-eluting coronary stent implantation.Methods A total of 400 patients,who had received rapamycin-eluting coronary stent implantation,were enrolled in this study.According to follow-up coronary angiography findings,the patients were divided into ISR group and non-ISR group.Plasma ox-LDL and Hcy levels were tested before percutaneous coronary intervention (PCI) as well as at the time of follow-up coronary angiography.Multivariate logistic regression analysis was used to evaluate ISR-related clinical parameters,angiographic features and surgical factors.Results ISR group had 48 patients and non-ISR group had 352 patients,the clinical incidence rate of ISR was 13.6％.Compared with non-ISR group,the plasma ox-LDL and Hcy levels tested before stent implantation and at the time of follow-up coronary angiography were strikingly increased,the differences were statistically significant (P＜0.05).The results of multivariate logistic regression analysis showed that the independent correlative factors for ISR included hypertension (OR=1.12,95％CI1.02-3.92;P=0.033),diabetes (OR=2.61,95％CI1.93-4.26;P=0.016 0),Hcy (OR=2.45,95％CI1.57-4.48;P=0.036),ox-LDL (OR=2.18,95％CI1.45-4.96;P=0.006),taking statins (OR=0.50,95％CI0.26-0.82;P=0.013),smoking (OR=5.62,95％CI4.13-7.18;P=0.002),coronary artery disease (OR=3.32,95％CI2.12-5.34;P=0.017),coronary bifurcation lesion (OR=3.51,95％CI2.36-5.58;P=0.021),chronic total occlusion (OR=2.01,95％CI1.22-4.84;P=0.014),reference vessel diameter (OR=0.25,95％CI0.12-0.62;P=0.001),preoperative vascular stenosis degree (OR=2.06,95％ CI1.21-4.32;P=0.024),stent diameter (OR=0.20,95％CI0.10-0.53;P=0.001) and stent length (OR=2.60,95％CI1.22-4.84;P=0.036).Conclusion Clinically,ISR is not an uncommon finding in patients who have received rapamycin-eluting coronary stent implantation.This study indicates that hypertension,diabetes,Hcy,ox-LDL,taking statins,smoking,coronary artery disease,coronary bifurcation lesion,chronic total occlusion,reference vessel diameter,preoperative vascular stenosis degree,stent diameter and stent length are the independent factors for ISR.Long-term use of statins can reduce the risk of ISR.