Alexandrescu Dan-Mihai, Mitu Ovidiu, Costache Irina Iuliana, Macovei Liviu, Mitu Ivona, Alexandrescu Anca, Georgescu Catalina Arsenescu
1 Medical Department, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.
Department of Cardiology-Internal Medicine, Emergency County Hospital, 610136 Piatra Neamt, Romania.
Exp Ther Med. 2021 Oct;22(4):1141. doi: 10.3892/etm.2021.10575. Epub 2021 Aug 9.
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.
本研究旨在探讨冠心病（CAD）患者经皮冠状动脉介入治疗（PCI）后，临床、生物学、影像学和手术因素与支架内再狭窄（ISR）风险之间的相关性。在一家大型PCI中心进行了为期2年的观察性横断面研究。共有235例连续诊断为心绞痛或急性冠状动脉综合征并接受PCI治疗的患者纳入研究。对有提示性冠状动脉症状且无创或有创辅助检查出现缺血性改变的患者，通过冠状动脉造影记录ISR的诊断。因此，他们被分为两组：有或无ISR。所有患者均接受了临床和实验室检查，提供了可被视为ISR危险因素的临床和辅助临床变量。当前吸烟者[风险比（RR）=1.63；95%置信区间（95%CI）：1.25 - 2.13]、动脉高血压（RR=1.86；95%CI：1.41 - 2.45）、糖尿病（RR=1.83；95%CI：1.42 - 2.36）、高C反应蛋白（CRP）水平（RR=1.44；95%CI：0.93 - 2.24）、慢性肾脏病（CKD）（RR=1.90；95%CI：1.53 - 2.36）和心肌梗死溶栓（TIMI）评分在评估ISR风险中具有重要作用。此外，与对照组（116例患者）相比，ISR组（119例患者）的支架膨胀压力较低（14.47 vs. 16.14 mmHg，P=0.004）。用于PCI的平均支架直径增加与高ISR发生率无关（P=0.810），以及使用较长支架治疗的复杂冠状动脉病变也无关（无ISR患者的平均长度为24.98 mm，有ISR患者为25.22 mm；P=0.311）。多支架置入和再狭窄程度>70%的风险估计高出两倍（RR=2.13；95%CI：1.17 - 3.88）。总之，吸烟、高血压、糖尿病、高CRP水平、CKD、TIMI评分、支架类型、低支架植入压力和多支架置入与PCI术后患者的ISR相关。因此，应对此类患者进行密切随访。
