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
. 2022 Aug 4;22(1):355.
doi: 10.1186/s12872-022-02762-y.

Association of serum apoA-I with in-stent restenosis in coronary heart disease

Xin Wang #  1 , Min Zhang #  2 , Jie Cheng  3 , Hua Zhou  4
Affiliations

Association of serum apoA-I with in-stent restenosis in coronary heart disease

Xin Wang et al. BMC Cardiovasc Disord. .

Abstract

Background: Despite use of drug-eluting stents (DES), in-stent restenosis (ISR) continues adversely affecting clinical outcomes of patients undergoing percutaneous coronary intervention (PCI). Apolipoprotein A-I (apoA-I) has athero-protective effects. However, there is a paucity of clinical data regarding the association between apoA-I and ISR. We sought to investigate whether serum apoA-I is related to ISR after DES-based PCI.

Methods: In this retrospective case control study, 604 consecutive patients who underwent DES implantation before were enrolled. Patients who underwent repeat angiography within 12 months were included in the early ISR study (n = 205), while those beyond 12 months were included in the late ISR study (n = 399). ISR was defined as the presence of > 50% diameter stenosis at the stent site or at its edges. Clinical characteristics were compared between ISR and non-ISR patients in the early and late ISR study, respectively, after adjusting for confounding factors by multivariate logistic regression, stratified analysis, and propensity score matching. The predictive value was assessed by univariate and multivariate logistic regression analysis, receiver operating characteristic (ROC) curve analysis, and quartile analysis.

Results: In the early ISR study, 8.8% (18 of 205) patients developed ISR. Serum apoA-I in the ISR group was lower than that in the non-ISR group (1.1 ± 0.26 vs. 1.24 ± 0.23, P < 0.05). On multivariate logistic regression analysis, apoA-I was an independent risk factor for early ISR. Incidence of early ISR showed negative correlation with apoA-I and could be predicted by the combined use of apoA-I and glycosylated hemoglobin (HbA1c) level. In the late ISR study, 21.8% (87 of 399) patients developed ISR. On subgroup analysis, late ISR showed negative correlation with apoA-I irrespective of intensive lipid lowering; on multivariate logistic regression analysis, apoA-I was also an independent risk factor for late ISR. In patients with intensive lipid lowering, combined use of apoA-I, stenting time, and diabetes predicted the incidence of late ISR.

Conclusions: ApoA-I was an independent risk factor for ISR, and showed a negative correlation with ISR after DES-based PCI. Combined use of apoA-I and clinical indicators may better predict the incidence of ISR under certain circumstances.

Keywords: Drug-eluting stents; In-stent restenosis; Prediction; apoA-I.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient enrollment
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) analysis using A apoA-I, B HbA1c, C apoA-I and HbA1c combined, to estimate the strength of the model predicting the incidence of early in-stent restenosis
Fig. 3
Fig. 3
Association of each apoA-I quartile with early ISR incidence, adjusted by three models
Fig. 4
Fig. 4
Receiver operating characteristic (ROC) curve analysis using A apoA-I, B stenting time, C apoA-I and diabetes combined, D apoA-I and stenting time combined, E apoA-I and stenting time and diabetes combined, to estimate the strength of the model predicting the incidence of late in-stent restenosis
Fig. 5
Fig. 5
Association of each apoA-I quartile with late ISR incidence in patients with intensive lipid-lowering, adjusted by three models
Fig. 6
Fig. 6
Receiver operating characteristic (ROC) analysis using apoA-I, to estimate the strength of the model predicting the incidence of late in-stent restenosis after PS matching
Fig. 7
Fig. 7
Association of each apoA-I quartile with late ISR incidence after PS matching, adjusted by three models
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Taniwaki M, Stefanini GG, Silber S, Richardt G, Vranckx P, Serruys PW, et al. 4-year clinical outcomes and predictors of repeat revascularization in patients treated with new-generation drug-eluting stents: a report from the RESOLUTE All-Comers trial (A randomized comparison of a zotarolimus-eluting stent with an everolimus-eluting stent for percutaneous coronary intervention) J Am Coll Cardiol. 2014;63:1617–1625. doi: 10.1016/j.jacc.2013.12.036. - DOI - PubMed
    1. Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF, et al. Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation. 1999;100:1872–1878. doi: 10.1161/01.CIR.100.18.1872. - DOI - PubMed
    1. Cassese S, Byrne RA, Schulz S, Hoppman P, Kreutzer J, Feuchtenberger A, et al. Prognostic role of restenosis in 10 004 patients undergoing routine control angiography after coronary stenting. Eur Heart J. 2015;36:94–99. doi: 10.1093/eurheartj/ehu383. - DOI - PubMed
    1. Kim MS, Dean LS. In-stent restenosis. Cardiovasc Ther. 2011;29:190–198. doi: 10.1111/j.1755-5922.2010.00155.x. - DOI - PubMed
    1. Jinnouchi H, Kuramitsu S, Shinozaki T, Tomoi Y, Hiromasa T, Kobayashi Y, et al. Difference of tissue characteristics between early and late restenosis after second-generation drug-eluting stents implantation—an optical coherence tomography study. Circ J. 2017;81:450–457. doi: 10.1253/circj.CJ-16-1069. - DOI - PubMed

MeSH terms

Substances

LinkOut - more resources