| Objective:To explore the risk factors of in-stent restenosis in ultra-high-risk ASCVD patients,predict the possibility of in-stent restenosis in ultra-high-risk ASCVD patients through common clinical indicators,providie evidence for secondary prevention in patients with ultra-high-risk ASCVD,and further improving the incidence of adverse cardiovascular events in patients with ultra-high-risk ASCVD.Methods:Patients with coronary heart disease who visited the Department of Cardiology of the First Hospital of Shanxi Medical University from January 2021 to December 2021 were continuously collected,and patients who had undergone stent implantation(PCI)within the past 2 years were selected,and 101 patients aged between 18 and 79 years were screened out according to the ultra-high-risk ASCVD standards,and these general data,laboratory data,examination data,and surgical data were collected.According to the results of this admission coronary angiography(CAG),it was divided into ISR group(n=33)and non-ISR group(n=68),and SPSS25.0 was used for statistical analysis,and univariate and multi-factor logistic regression were performed on statistically significant variables with differences,and the independent risk factors of ISR were screened out.Results:(1)101 cases were enrolled,of which 78.3% had ≥2 serious cardiovascular events;21.7%had 1 serious cardiovascular event combined with ≥2 high risk factors.LDL-C compliance rate of 10%.(2)The variables with statistically significant differences(P<0.05)in the two groups of general data were: history of diabetes,ALT,AST,RDW-SD,glycosylated hemoglobin(%),TC,LDL-C,carotid arteriosclerosis,NT-pro BNP;no statistically significant(P>0.05)of the two sets of variables were: sex,diabetes history,hypertension history,peripheral vascular history,family coronary heart disease history,smoking history,alcohol history,age,BMI,eGFR,glycosylated hemoglobin,TG,HDL-C,homocynine,fatty liver,LVEF,left ventricular diastolic function.There were statistically significant differences in coronary artery lesions and stent implantation between the two groups(P<0.05)in the following variables: stent length,stent diameter,stent number and Gensini score.There was no statistically significant difference between the two groups(P>0.05)in the following variables: stent series and stent implantation location.(3)Univariate logistic regression analysis showed that ALT,RDW-SD,TC,LDL-C,carotid atherosclerosis,NT-pro BNP,Gensini score,carotid atherosclerosis,number of stents,length of stents,and diameter of stents(P<0.05)might be candidate risk factors for ISR in ultrahigh-risk ASCVD.(4)Multivariate logistic regression analysis: Logistic regression equations were constructed by including candidate risk factors: the increase in RDW-SD will increase the risk of ISR in ultra-high-risk ASCVDs,which is statistically significant(OR=6.442,95% CI 1.228-33.797,P=0.028);the increase in LDL-C will increase the risk of ISR in ultra-high-risk ASCVDs,which is statistically significant(OR=17.515,95% CI 2.550-120.326,P=0.004);the longer the length of the stent,the greater the risk of ISR occurrence,and the difference was statistically significant(OR=14.686,95% CI 2.222-97.053,P=0.005);the higher the risk of ISR occurring,and the difference was statistically significant(OR=17.323,95% CI 2.145-139.920,P=0.007).Conclusion:1.Higher levels of LDL-C are risk factors for the development of ISR in ultra-high-risk ASCVD.The LDL-C compliance rate of ultra-high-risk ASCVD patients in this study was at a low level,and further lipid lowering is still needed.2.Higher levels of RDW-SD are risk factors for the occurrence of ISR in ultra-high-risk ASCVD.Controlling chronic inflammation throughout the body further reduces the incidence of in-stent stenosis in patients with ultra-high-risk ASCVD.3.Longer stent length,more stent number are risk factors for the occurrence of ISR in ultrahigh-risk ASCVD.Selecting suitable stents for PCI in patients with ultra-high-risk ASCVD may reduce the occurrence of ISR. |
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