Risk Score For In-stent Restenosis In Patients Implanted Coronary Stents

BackgroundCoronary heart disease(CHD)is one of the most common cardiovascular diseases.There are more than 11 million patients in China.Percutaneous coronary intervention(PCI)is an effective and commonly used method in the treatment of CHD.With the progress of PCI technology and the popularization of PCI technology in primary hospitals,more and more CHD patients benefit from drug-eluting stents.However,in stent restenosis(ISR)is a common complication of PCI,which seriously affects the effect of interventional therapy and threatens the health of CHD patients.At present,the risk factors of ISR are not completely clear.In order to better identify the ISR group,this study retrospectively analyzed the patients after PCI,screened out the risk factors of ISR events,and established the ISR risk score system,in order to screen out the ISR high-risk group as soon as possible.ObjectPatients who had undergone coronary drug-eluting stent implantation in the past and underwent selective coronary angiography in the Department of Cardiology of Nanfang Hospital from August 2018 to July 2020 were selected as the study group.Patients who had undergone coronary drug-eluting stent implantation and underwent selective coronary angiography in the Department of Cardiology of Nanfang Hospital from August 2021 to February 2021 were selected as the study group.After strictly implementing the inclusion and exclusion criteria,468 patients were finally included in the study group and 233 patients were included in the validation group.MethodThe clinical data of patients meeting the inclusion criteria were collected,including:①clinical information of patients:gender,age,BMI,antiplatelet drugs,chronic history(hypertension,diabetes),family history of CHD,contact information,ID number,hospitalization number,smoking history;②auxiliary examination:cardiac troponin I(cTnI),glycosylated hemoglobin,triglyceride(TG),total cholesterol(TC),Low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),serum creatinine(Scr),uric acid,D-dimer,left ventricular ejection fraction(LVEF);③coronary artery condition:thrombus load,chronic total occlusion(CTO).④Stent condition:number,length,diameter,time,whether in series,whether bifurcation operation.SPSS 20.0 was used to analyze the data,and univariate logistic regression model was used to screen out the candidate variables of risk factors of coronary artery ISR.Multivariate logistic regression analysis included the variables of P<0.05 in univariate logistic regression analysis to establish the model and obtain the risk factors related to coronary artery ISR in this study.According to the regression coefficient β value of multivariate logistic regression analysis,the corresponding score was given,and the ISR risk score system was established.The application performance of the risk scoring system was evaluated by the area under the receiver operating characteristic(ROC)curve(AUC)and the Hosmer lemeshows goodness of fit.ResultMultivariate logistic regression analysis showed that LDL-C,EGFR,stent time,smoking after PCI,and bifurcation operation were independent risk factors for ISR.According to β value,LDL-C>3.4 mmol/L(2 scores);eGFR≤45 ml/min/1.73 m2(1 score);stent time≥5 years(3 scores);smoking after PCI(1 score);bifurcation operation(1 score).The area under ROC curve of ISR risk score system was 0.827,and the goodness of fit of Hosmer lemeshows was p=0.558.When the judgment score was 2,it was the best critical point on the ROC curve,and the corresponding sensitivity and specificity were 73.7%and 85.8%,respectively.ConclusionISR risk scoring system includes five risk factors,with a total score of 0-8.2 points is used as the judgment score.The high-risk group is more than 2 scores,and the low-risk group is less than 2 scores.It is a convenient,accurate and feasible risk assessment tool.