Study On Intraluminal Imaging And Biomarkers Of Coronary Artery In-stent Restenosi

Part Ⅰ Analysis of optical coherence tomography findings of recurrent in-stent restenosisObjective:To clarify the differences between the mechanisms of recurrent in-stent restenosis and non-recurrent in-stent restenosis by optical coherence tomography evaluation.Methods:A total of 52 patients with in-stent restenosis after drug-eluting stent implantation who underwent optical coherence tomography assessments in Chinese Academy of Medical Sciences Fuwai Hospital from January 2015 to December 2019 were retrospectively enrolled,and the patients were divided into R-ISR group(n=16)and nonrecurrent in-stent restenosis group(n=36).The data on patient demographics,cardiovascular risk factors,ancillary tests,previous interventional treatments,and other medical history were collected.The coronary angiography and optical coherence tomography images were analyzed qualitatively and quantitatively.To compare the difference of lesion characteristics between recurrent in-stent restenosis and non-recurrent in-stent restenosis.Results:There was no significant difference between recurrent in-stent restenosis and nonrecurrent in-stent restenosis patients with cardiovascular risk factors such as hypertension,hyperlipidemia,diabetes mellitus,smoking history,family history of coronary heart disease,and coronary angiographic characteristics such as lesion location,in-stent restenosis classification,reference vessel diameter,target lesion length(all P>0.05).The proportion of homogeneous neointima in recurrent in-stent restenosis patients(43.8%)was significantly higher than that in non-recurrent in-stent restenosis patients(19.4%),and the proportion of neoatherosclerosis(43.8%)was significantly lower in recurrent in-stent restenosis patients than that in non-recurrent in-stent restenosis patients(75%)(P<0.05).Conclusion:As no difference in cardiovascular risk factors,patients with recurrent instent restenosis showed a higher proportion of homogeneous neointimal,revealed an important mechanism for recurrent in-stent restenosis.Part Ⅱ Long term prognosis and risk factors of intracoronary imaging guided percutaneous coronary intervention for in-stent restenosisObjective:To evaluate the clinical characteristics,long-term outcomes and predictors of the adverse events in patients underwent in-stent restenosis percutaneous coronary intervention guided by optical coherence tomography,intravascular ultrasound,and coronary angiography.Methods:A total of 79 patients with drug-eluting stent restenosis treated under the guidance of optical coherence tomography in Chinese Academy of Medical Sciences Fuwai Hospital from January 2015 to December 2019 were retrospectively enrolled and matched by age,sex and admission date in a 1:1 ratio with the patients guided by intravascular ultrasound or coronary angiography.The data on patient demographics,cardiovascular risk factors,ancillary tests,and other medical history were collected,patients were followed up by telephone or outpatient clinic,and MACE(cardiac death,myocardial infarction,target vessel revascularization and stroke)was used as study primary endpoints to compare the long-term prognosis among the three groups and to analyze their predictive factors.Results:During a mean follow-up of 3.2±1.4 years,the primary endpoint(log rank P=0.033)was significantly more frequent in the coronary angiography group than in the other 2 groups,the differences in the incidence of primary endpoint(log rank P=0.453)between optical coherence tomography and intravascular ultrasound groups were not statistically significant.COX hazard proportional model analysis showed that intracoronary imaging guided percutaneous coronary intervention remained an independent protective factor for MACE(HR=0.447,95%CI:0.200-0.998,P=0.049).Conclusions:The intracoronary imaging guided percutaneous coronary intervention in patients with in-stent restenosis is an independent protective factor for long-term MACE,and the long-term prognosis of percutaneous coronary intervention guided by optical coherence tomography and intravascular ultrasound is similar.Part Ⅲ Predictive value of plasma big endothelin-1 in adverse events of patients with coronary artery restenosis and diabetes mellitusObjective:This study aims to identify the potential association between big ET-1 and clinical prognosis,and to determine whether big ET-1 has an incremental effect on risk stratification on the basis of traditional risk factors in patients with in-stent restenosis and diabetes.Methods:Retrospective analysis of patients with drug-eluting stent restenosis in Chinese Academy of Medical Sciences Fuwai Hospital from January 2017 to December 2018.The patients were divided into 3 groups according to the tertiles of big ET-1.The primary endpoint was a composite endpoint of the cardiac death,non-fatal myocardial infarction,target lesion revascularization and stroke.A COX multivariate proportional hazard model was constructed to evaluate the association between big ET-1 and the long-term outcomes.Results:A total of 1574 patients with in-stent restenosis were included in this study,of which 795 patients were diabetic patients.Compared with non-diabetic patients,patients with in-stent restenosis and diabetes have significantly higher levels of big ET-1(0.26 vs.0.23,P<.0001).During an average follow-up of 2.96±0.56 years,patients with in-stent restenosis and diabetes with big ET-1 Tertile3 had a significantly higher incidence of primary endpoint events(Log-Rank P=0.043).Multivariate COX proportional hazard model analysis showed that the increase of big ET-1 was independently related to the increase in the risk of the primary endpoint event,and was not related to other traditional cardiovascular risk factors(HR:1.75,95%CI:1.23～2.49,P=0.002),taking the Tertile1 group as a reference,the HRs(95%CI)of big ET-1 in the Tertile2 group and the Tertile3 group were 1.35(0.59～3.11)and 2.36(1.10～5.08),respectively.In addition,adding big ET-1 to the model constructed by traditional cardiovascular risk factors increased the C statistic(0.60 vs 0.64,P=0.03).Conclusion:Elevated plasma big ET-1 was associated with worse clinical outcomes in patients with in-stent restenosis and diabetes.