The diagnostic value of long noncoding RNAs as a biomarker for in-stent restenosis in patients with coronary heart disease: A systematic review and meta-analysis of diagnostic test accuracy studies.

BACKGROUND

The diagnostic utility of long noncoding RNAs (lncRNAs) in detecting in-stent restenosis (ISR) among coronary heart disease (CHD) patients has drawn significant research interest. Despite this attention, however, only a limited number of lncRNAs have been translated into clinical applications. This study seeks to systematically assess the diagnostic accuracy of lncRNAs for identifying ISR in the CHD population.

METHODS

This meta-analysis was registered with PROSPERO (CRD420251105086).A systematic search was performed across PubMed, Web of Science, EMBASE, Wanfang, CNKI, and VIP to retrieve studies evaluating the diagnostic accuracy of lncRNAs for ISR in CHD patients, with a publication cutoff of July 2025. The diagnostic performance of lncRNAs was assessed using pooled sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), summary receiver operating characteristic curve area (AUC), and diagnostic odds ratio (DOR). Statistical analyses were conducted using STATA 14.0 software.

RESULTS

A total of 7 studies involving 1020 patients were included in the analysis. The diagnostic performance of lncRNAs for identifying ISR in CHD patients was evaluated using sensitivity, specificity, PLR, NLR, DOR, and AUC. Pooled estimates revealed a sensitivity of 0.81 (95% CI: 0.75-0.86) and specificity of 0.79 (95% CI: 0.75-0.82). Corresponding PLR, NLR, and DOR were 3.8 (95% CI: 3.2-4.6), 0.24 (95% CI: 0.18-0.32), and 16 (95% CI: 11-24), respectively. The summary AUC was 0.86 (95% CI: 0.83-0.89).Subgroup analyses demonstrated significantly higher diagnostic accuracy for lncRNAs in patients with follow-up times ≤ 12 months (AUC: 0.88) compared to those with follow-up times > 12 months (AUC: 0.81). Studies with sample sizes > 100 cases exhibited superior performance (AUC: 0.89) versus those with ≤ 100 cases (AUC: 0.84). Serum-based lncRNA measurements showed a significantly higher AUC (0.89) than non-serum specimens (0.83). Diagnostic performance also varied by detection method, with RT-PCR demonstrating a higher AUC (0.87) compared to RT-qPCR (0.86). Notably, down-regulated lncRNAs exhibited better diagnostic utility (AUC: 0.86) than up-regulated lncRNAs (AUC: 0.82).

CONCLUSION

LncRNAs demonstrate substantial diagnostic accuracy for detecting ISR in CHD patients. Nevertheless, further large-scale, prospective studies are required to validate their clinical utility and clarify their underlying molecular mechanisms.