Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;22(4):1141.
doi: 10.3892/etm.2021.10575. Epub 2021 Aug 9.

Risk factors associated with intra-stent restenosis after percutaneous coronary intervention

Dan-Mihai Alexandrescu  1   2 , Ovidiu Mitu  1 , Irina Iuliana Costache  1 , Liviu Macovei  1 , Ivona Mitu  3 , Anca Alexandrescu  2 , Catalina Arsenescu Georgescu  1
Affiliations

Risk factors associated with intra-stent restenosis after percutaneous coronary intervention

Dan-Mihai Alexandrescu et al. Exp Ther Med. 2021 Oct.

Abstract

The present study aimed to explore the correlations between clinical, biological, imagistic and procedural factors with the risk of intra-stent restenosis (ISR) in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). An observational cross-sectional study was conducted in a high-volume PCI center over a period of 2 years. A total of 235 consecutive patients diagnosed with angina or acute coronary syndrome treated by PCI were included in the study. Diagnosis of ISR was documented by coronary angiography in patients with suggestive coronary symptoms and ischemic changes in non-invasive or invasive paraclinical investigations. Thus, they were assigned to two groups: With or without ISR. All patients underwent clinical and laboratory examination, providing clinical and paraclinical variables that could be considered risk factors for ISR. Current smokers [risk ratio (RR)=1.63; 95% confidence interval (95% CI): 1.25-2.13], arterial hypertension (RR=1.86; 95% CI: 1.41-2.45), diabetes (RR=1.83; 95% CI: 1.42-2.36), high C-reactive protein (CRP) levels (RR=1.44; 95% CI: 0.93-2.24), chronic kidney disease (CKD) (RR=1.90; 95% CI: 1.53-2.36) and thrombolysis in myocardial infarction (TIMI) score were found to have a significant role in estimating the risk for ISR. Moreover, the ISR group (119 patients) presented with a lower stent inflation pressure when compared to the control group (116 patients) (14.47 vs. 16.14 mmHg, P=0.004). An increased mean stent diameter used for PCI was not associated with a high ISR incidence (P=0.810) as well as complex coronary treated lesions with longer stents (mean length of 24.98 mm in patients without ISR vs. 25.22 mm in patients with ISR; P=0.311). There was an estimated two times higher risk (RR=2.13; 95% CI: 1.17-3.88) concerning multi-stenting and restenosis degree >70%. To conclude, smoking, hypertension, diabetes mellitus, high CRP levels, CKD, TIMI score, stent type, low pressure for stent implantation and multi-stenting were found to be associated with ISR in patients following PCI. Therefore, a close follow-up should be targeted in such patients.

Keywords: BMS; DES; coronary artery disease; percutaneous coronary intervention; risk factors; stent restenosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Correlation between type of stent, time prior to stenting procedure and time course of restenosis. DES, drug-eluting stents; BMS, bare-metal stents.
Figure 2
Figure 2
Correlation between mean stent inflation pressure and restenosis.
Figure 3
Figure 3
Correlation between stent diameter and restenosis.
Figure 4
Figure 4
Correlation between stent length and restenosis.
Figure 5
Figure 5
Correlation between multi-stenting and restenosis degree.
See this image and copyright information in PMC

References

    1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the global burden of disease study. Lancet. 2012;380:2095–2128. doi: 10.1016/S0140-6736(12)61728-0. - DOI - PMC - PubMed
    1. Alfonso F, Byrne RA, Rivero F, Kastrati A. Current treatment of in-stent restenosis. J Am Coll Cardiol. 2014;63:2659–2673. doi: 10.1016/j.jacc.2014.02.545. - DOI - PubMed
    1. Alfonso F. Treatment of drug-eluting stent restenosis the new pilgrimage: Quo vadis? J Am Coll Cardiol. 2010;55:2717–2720. doi: 10.1016/j.jacc.2010.03.026. - DOI - PubMed
    1. Rao G, Sheth S, Grines C. Percutaneous coronary intervention: 2017 in review. J interv Cardiol. 2018;31:117–128. doi: 10.1111/joic.12508. - DOI - PubMed
    1. Baschet L, Bourguignon S, Marque S, Durand-Zaleski I, Teiger E, Wilquin F, Levesque K. Cost-effectiveness of drug-eluting stents versus bare-metal stents in patients undergoing percutaneous coronary intervention. Open Heart. 2016;3(e000445) doi: 10.1136/openhrt-2016-000445. - DOI - PMC - PubMed