Risk Factors Of Stent Restenosis In Patients With Acute ST-segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention

Objective:To investigate the risk factors of in-stent restenosis after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction.Methods:A total of 424 patients who were diagnosed with acute ST-segment elevation myocardial infarction and underwent PCI at the Department of Cardiology,Xianyang Hospital of Yan ’an University from January 2017 to December 2021 and underwent coronary angiography after PCI(angiography review time was 12-24 months)were retrospectively collected.31 patients who did not meet the inclusion criteria were excluded.According to the results of re-angiography,the patients were divided into in-stent restenosis group(ISR group,n=39)and in-stent non-restenosis group(non-ISR group,n=354).The clinical data of the patients were comprehensively recorded.The t test and X2 test were used to compare the measurement data and count data between the two groups,respectively.Pearson correlation or Spearman rank correlation was used for correlation analysis.Further use binary logistic regression to analyze the influencing factors of stent restenosis after percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction.The receiver operating characteristic curve(ROC)and area under curve(AUC)were used to evaluate the performance of risk factors in predicting ISR,and the critical point was calculated by maximizing the Jordan index.Results:(1)Comparison of clinical data between the two groups showed that age(t=-2.521,P=0.012),TC(t=-3.867,P < 0.001),LDL-C(t=4.541,P < 0.001),TyG index(t=6.147,P < 0.001)between the two groups.P < 0.001),Gensini score(t=5.396,P < 0.001),Lp(a),TG,Apo B,FBG,Cr,D-dimer,WBC and SBP were significantly different between the two groups(P < 0.05).(2)The correlation analysis between TyG index and other variables in ISR group showed TC(R=0.248,P < 0.001),LDL-C(R= 0.312,P < 0.001),TG(r=0.558,P < 0.001),Apob(r=0.297,P < 0.001),LDL-C(r= 0.312,P < 0.001).FBG(r=0.565,P < 0.001),D-dimer(r= 0.216,P=0.001),Gensini score(R=0.272,P=0.001)were significantly correlated with TyG index(P < 0.05).(3)The results of PCI operation in the two groups showed that there were significant differences in severe calcified lesions(X2=4.334,P=0.030)and stent length(t=2.616,P=0.009)between the two groups(P < 0.05).However,there were no significant differences in infarct-related artery stent placement,multi-vessel disease,thrombotic disease,diffuse long lesions,bifurcation lesions,TIMI flow grade,number of stents,and stent diameter between the two groups(P > 0.05).(4)IVUS detection and analysis of the lesions with restenosis showed stent atelectasis in 7 cases,stent malapposition in 24 cases,neovascularization in 32 cases,intimal hyperplasia in 33 cases,stent fracture in 0 case,and stent thrombosis in 1 case.(5)Multivariate Logistic regression analysis was performed on the occurrence of in-stent restenosis.LDL-C(OR=2.494,95% CI 1.224-5.08,P=0.012),Lp(a)(OR=1.006,95% CI 1.002-1.009,P=0.001),WBC(OR=1.186,95%)were finally determined Ci1.055-1.333,P=0.004),TyG index(OR=3.683,95% CI 1.414-9.588,P=0.008),stent length(OR=1.13,95% CI 1.414-9.588,P=0.008)Ci1.044-1.224,P=0.003)Gensini score(OR=1.024,95% CI 1.011-1.038,P= < 0.001)was the main risk factor for ISR in STEMI patients after percutaneous coronary intervention.Conclusion:(1)LDL-C,Lp(a),WBC,Gensini score,TyG index and stent length are the main risk factors for in-stent restenosis after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction.(2)TyG index was significantly correlated with Gensini score in patients with in-stent restenosis.