Seo Duck-Jun, Kim Yong-Kyun, Seo Young-Hoon, Song In-Geol, Kim Ki-Hong, Kwon Taek-Geun, Park Hyun-Woong, Bae Jang-Ho
Konyang University Hospital.
Cardiol J. 2018;25(1):7-13. doi: 10.5603/CJ.a2017.0124. Epub 2017 Oct 24.
The mechanism of in-stent restenosis (ISR) is multifactorial, which includes biological, mechanical and technical factors. This study hypothesized that increased inflammatory reaction, which is known to be an important atherosclerotic process, at a culprit lesion may lead to higher restenosis rates.
The study population consisted of 241 patients who had undergone percutaneous coronary intervention with virtual histology-intravascular ultrasound (VH-IVUS) and a 9-month follow-up coronary angiography. Compared herein is the coronary plaque composition between patients with ISR and those without ISR.
Patients with ISR (n = 27) were likely to be older (66.2 ± 9.5 years vs. 58.7 ± 11.7 years, p = 0.002) and have higher levels of high-sensitivity C-reactive protein (hs-CRP, 1.60 ± 3.59 mg/dL vs. 0.31 ± 0.76 mg/dL, p < 0.001) than those without ISR (n = 214). VH-IVUS examination showed that percent necrotic core volume (14.3 ± 8.7% vs. 19.5 ± 9.1%, p = 0.005) was higher in those without ISR than those with ISR. Multivariate analysis revealed that hs-CRP (odds ratio [OR] 3.334, 95% con-fidence interval [CI] 1.158-9.596, p = 0.026) and age (OR 3.557, 95% CI 1.242-10.192, p = 0.018) were associated with ISR.
This study suggests that ISR is not associated with baseline coronary plaque composition but is associated with old age and increased expression of the inflammatory marker of hs-CRP. (Cardiol J 2018; 25, 1: 7-13).
支架内再狭窄（ISR）的机制是多因素的，包括生物学、机械和技术因素。本研究假设，已知作为重要动脉粥样硬化过程的炎症反应增加，在罪犯病变处可能导致更高的再狭窄率。
研究人群包括241例行虚拟组织学血管内超声（VH-IVUS）检查并进行9个月随访冠状动脉造影的经皮冠状动脉介入治疗患者。本文比较了ISR患者和非ISR患者的冠状动脉斑块成分。
ISR患者（n = 27）比非ISR患者（n = 214）年龄更大（66.2±9.5岁对58.7±11.7岁，p = 0.002）且高敏C反应蛋白（hs-CRP）水平更高（1.60±3.59mg/dL对0.31±0.76mg/dL，p <0.001）。VH-IVUS检查显示，非ISR患者的坏死核心体积百分比（14.3±8.7%对19.5±9.1%，p = 0.005）高于ISR患者。多因素分析显示，hs-CRP（比值比[OR] 3.334，95%置信区间[CI] 1.158 - 9.596，p = 0.026）和年龄（OR 3.557，95% CI 1.242 - 10.192，p = 0.018）与ISR相关。
本研究表明，ISR与基线冠状动脉斑块成分无关，而是与老年和hs-CRP炎症标志物表达增加有关。（《心脏病学杂志》2018年；25卷，第1期：7 - 13页）
