Risk Factors For Drug-eluting Stent Restenosis In Diabetic And Non-diabetic Patients

Objective: In-stent restenosis(ISR)is the main cause of stent implantation failure.Among the risk factor of IRS,type 2 diabetes mellitus(DM),as an important independent risk factor,has attracted much attention.Due to the complex pathophysiological characteristics of DM,the other risk factors of IRS may be differentfrom that of non-diabetic mellitus(non-DM)population,but no relevant reports have been reported.Therefore,the purpose of our study was to explore the differences in risk factors related to IRS between DM and non-DM populations.Methods: A total of 583 patients who underwent coronary angiography after stent implantation in Subei people’s Hospital from June 2017 to September 2019 were selected.The patients ranged in age from 28 to 91 years old,with an average age of68.17 years old,including 429 males and 154 females.The patient’s medical history and treatment plan were reviewed to exclude malignant tumors,recent history of major surgical trauma,history of coronary artery bypass grafting,systemic immune diseases and immunosuppressant application,hematological diseases,long-term oral drugs that affect hemocytogenesis and metabolism,and long-term use of drugs that affect uric acid metabolism.The two groups were divided into the DM group and the non-DM group according to the presence or absence of DM.The two groups were then divided into the ISR group and the non in stent restenosis(non-ISR)group according to the results of coronary angiography.The grouping was as follows: there were 220 patients in the DM group,including 151 males and 69 females.According to the angiography results,78 patients were divided into the ISR group and 142 patients in the non-ISR group.There were 363 patients in the non-DM group,including 278 males and 85 females.According to the angiography results,82 patients were divided into the ISR group and 281 patients in the non-ISR group.Collecting all of the patients medical history(type 2 DM,high blood pressure,etc.),past medical history,Previous number and specification of implanted stents,uric acid,C-reactive protein,electrolytes,blood routine,blood bilirubin and so on in Fasting state before Coronary angiography.And using the SPSS23.0 statistical software for statistical analysis of data processing,measurement data using(plus or minus S.E.)said,measurement data using frequency and percentage(%);The measurement data were compared by independent sample t test,Wilcoxon rank sum test and the counting data were compared by chi-square test.P<0.05(double tail)was determined to be statistically significant.Multivariate logistic regression analysis was used to identify the independent predictor of ISR.Two-tailed P values less than0.05 were considered significant and the confidence interval was 95%.Results:(1)In diabetes mellitus(DM)group :In stent restenosis(ISR)group time of reexamination after stent implantation(6.00 vs.2.00 years),NLR(3.00 vs.2.68)were significantly higher than the non-in stent restenosis(non-ISR)group;the Apo AI/HDL(1.16 vs.2.27),utilization ratio of beta blockers(80.8% vs 94.4%),calcium concentration(2.27 vs.2.30 tendency/l)and statins(71.8% vs 86.6%)were lower than those of non-ISR group;(2)In non-diabetes mellitus(non-DM)group :In ISR group,age(71.00 vs 69.00 years),time of reexamination after stent implantation(7.00 vs 3.00years),LDL/Apo B(2.59 vs 2.46 years),neutrophil(4.59 vs3.89 FL),Neutrophil lymphocyte ratio(NLR)(3.22 vs 2.64 FL),conjugated bilirubin(4.00 vs 1.20 FL),conjugated bilirubin/unconjugated bilirubin(0.41 vs 0.10 umol/l)were all significantly higher than those in the non-ISR group(P<0.05).In the multivariate logistic regression analysis,in DM group,the time of reexamination after stent implantation(P=0.000,OR=0.770)was an independent risk predictor of ISR,with a positive correlation.In non-DM group,the time of reexamination after stent implantation(P= 0.000,OR=0.854),LDL/Apo B(P=0.029,OR=0.388),TC/HDL(P=0.021,OR=0.564),and conjugated bilirubin(P=0.023,OR=0.814)were independent risk predictor of ISR,with a positive correlation.Conclusion: Between with DM and non-DM group,the risk factors and independent risk predictors of ISR are different.In the DM group:In stent restenosis(ISR)group time of reexamination after stent implantation,and NLR were significantly higher than the non-in stent restenosis(non-ISR)group;the calcium concentration,Apo AI/HDL,utilization ratio of beta blockers and statins were lower than those of non-ISR group;In non-diabetes mellitus(non-DM)group :In ISR group,age,time of reexamination after stent implantation,LDL/Apo B,neutrophil,Neutrophil lymphocyte ratio(NLR),conjugated bilirubin,conjugated bilirubin/unconjugated bilirubin were all significantly higher than those in the non-ISR group(P<0.05).In the multivariate logistic regression analysis,in DM group,the time of reexamination after stent implantation was anindependent risk predictor of ISR,with a positive correlation.In non-DM group,the time of reexamination after stent implantation,LDL/Apo B,TC/HDL,and conjugated bilirubin were independent risk predictor of ISR,with a positive correlation.