Clinical Analysis Of Risk Factor Of Restenosis After Coronary Stenting

Background：Coronary atherosclerotic heart disease is a serious threat to the health andsafety of human life. Since the mid80’s of last century to now, with the rapid developmentand application of the percutaneous coronary intervention (PCI), PCI has been the coronaryheart disease is one of the main treatment methods. But the problem of restenosis aftercoronary stenting is still puzzling all the clinical physicians, and affecting patients undergoingcoronary stenting of long-term prognosis.Although after many unremittingly efforts, the rateof restenosis after coronary stenting declines, but still has a10%-20%percentage afterstenting in patients with in stent restenosis (ISR), how to solve the problem of restenosis aftercoronary stenting has become a problem in the treatment of coronary heart disease. Thestudies show that restenosis after coronary stenting is caused by a variety of factors. Ourexperiment analyze the clinical datas of patients with coronary stent implantation, the riskfactors of restenosis in clinical and biochemical markers,such as analysis of characteristics ofcoronary lesions after coronary stenting retrospectively.Objective: To recheck CAG (coronary angiography) to analysis the possible reasons ofin-stent restenosis (ISR) through following-up patients who accepted PCI (percutaneouscoronary intervention) therapy.Method Choose179cases (249Target lesions) that patients received successful stentimplantation and follow-up coronary angiography from Jilin University cardiovasculardiagnosis and treatment center from January2013to December,2013. Divid these patientsinto the restenosis group and non-restenosis group according to the result of coronaryangiography. The stenosis of the vessel diameter of the original stent confirmed by coronaryangiography>50%is defined as restenosis after coronary stenting.The restenosis group are34cases, and the non-restenosis are145cases. Make a retrospective analysis of the two groups ofpatients’ medical history, biochemical index and coronary artery lesions, and adopt the singlefactor and Logistic regression analysis on the relationship between them and restenosis after coronary stenting.Result Through single factor analysis, the results show that the difference between thetwo groups of diabetes, smoking, lipoprotein a, serum total bilirubin, the diameter of thestent, the length of stent, the degree of stenosis, multiple stents implanted in series isstatistical (p<0.05).(1) The prevalence rate (47.1%) of diabetes mellitus of the restenosisgroup is significantly higher than that of non-restenosis group(26.2%).(2) The Smoking rate(32.3%) of the restenosis group was significantly higher than non-restenosis group (15.9%).(3) The restenosis group have a significantly higher level of lipoprotein a than that ofnon-restenosis group (0.51±0.39g/L VS0.34±0.27g/L).(4) The restenosis group have asignificantly higher level of serum total bilirubin than that of non-restenosis group(10.66±2.16VS12.11±3.56)(5) The the length of stent of restenosis group is longer thannonrestenosis group(44.08±21.19mm VS35.39±18.42mm).(6) The diameter of the stent ofthe restenosis group is smaller than that of non-restenosis group (2.93±0.33mm VS3.07±0.32mm).(7) The number of stents implanted of restenosis group is more than non-restenosisgroup (1.69±0.74VS1.40±0.59), the series stand incidence of restenosis group is higher thannon-high restenosis52.9%VS32.3%).(8) The degree of target lesion of stenosis group(92.01±8.16%) is severity than non-restenosis group (89.30±8.66%).Multivariate logistic regression analysis shows that smoking (OR=2.529,95%CI1.012~6.325), diabetes (OR=2.928，95%CI1.284~6.675), lipoprotein a (OR=4.293,95%CI1.303~14.145）, and the length of stent (OR=1.023,95%CI1.007~1.039), the degree of targetlesion (OR=1.041,95%CI1.012~1.085) are high risk factors of restenosis after coronarystenting, whereas the diameter of the stent (OR=0.152,95%CI0.047~0.490) and the serumtotal bilirubin level (OR=0.854,95%CI0.740~0.986) are protective factors for restenosisafter coronary stenting.Conclusion：Smoking, diabetes, the level of lipoprotein a, the level of serumtotal bilirubin, stentdiameter, the length of stent, the series of coronary stents, the degree of target lesion arerelated with restenosis after coronary stenting.(1) The prevalence rate of diabetes mellitus, smoking rate of postoperative, the level oflipoprotein a of the restenosis group were higher than that of non-restenosis group. They were high risk factors of restenosis after coronary stenting.(2) Higher levels of serum total bilirubin were protective factors of in-stent restenosis.(3) Multiple stents implanted in series, longer stent will increase the restenosis，suggesting diffuse long lesions are risk factors for restenosis.(4) The target lesion stenosis more severe the greater the likelihood of restenosis.(5) Larger diameter of the stent are protective factors from restenosis after coronarystenting.