The Related Factors Of In-stent Restenosis In Young And Middle Aged With Coronary Heart Disease

Objective:To determine the related factors of restenosis in patients with coronary heart disease in young and middle aged PCI stent, it provided theoretical basis for young patients with coronary heart disease in the prevention of restenosis in stent.Methods: A retrospective analysis from 2012 January to 2014 August in Affiliated Hospital of Jining Medical College, 4730 patients underwent coronary artery stent implantation patients. according to the age, were divided according to age for two groups, young and middle-aged group(age < 65 years old) and elderly group(aged 65 years),randomly selected 500 young and middle-aged patients and 500 elderly patients and follow-up by outpatient and telephone. The total of 1000 patients were enrolled, 928 cases were followed up, 72 cases were lost,the follow-up rate was 92.8%. In these cases, 705 patients were selected for coronary CT, and no ISR patients were identified.And after 1 years within coronary angiography follow-up of patients studied, 223 patients were randomly selected: Including 114 cases of ISR group, namely with the stent segment diameter stenosis 50% to restenosis; the other 109 cases as ISR group, namely the stent and stent proximal and distal stenosis <50%. Divided into stent restenosis group(114 cases) and non-restenosis group stent(109), restenosis group according to the divided into youngand middle aged in restenosis group(63 cases), the elderly restenosis group(51 cases). Differences in a retrospective analysis of patients with clinical data, clinical and biochemical indexes before and after coronary angiography results, using single factor and multi factor Logistic regression analysis of the correlation of coronary artery in patients with coronary heart disease in young and middle aged in stent restenosis.Result:Single factor analysis showed:The statistic differences between restenosis group and non-restenosis group were found in smoking, hypertension,total cholesterol and low density lipoprotein. ①Smoking rate in restenosis group is higher than that non-restenosis group(68.97% vs 39.21%, t=7.816,P=0.008);②Hypertension prevalence rate in restenosis group is higher than that non-restenosis group(74.60%vs 47.06%, t=6.749,P=0.028); ③ Total cholesterol level in restenosis group is higher than that non-restenosis group(5.13±1.06 vs 4.38±2.62,χ2=6.473,P=0.041).④Low density lipoprotein levels in restenosis group is higher than that non-restenosis group(3.08±0.26 vs 2.12±0.37,χ2=7.830,P=0.037).In the multivariate logistic regression analysis model,smoking(OR=2.053, P=0.003), hypertension(OR=2.84, P=0.009), total cholesterol(OR=0.81, P=0.024)in patients with low density lipoprotein(OR=0.90, P=0.034) are risk factors of coronary artery in stent restenosis.Smoking(OR = 2.281, P=0.002) and hypertension(OR = 2.146,P=0.007) and the correlation of young and middle-aged ISR isstronger.Comparing young and middle-aged group and elderly group by smoking stratified analysis results showed: the rate of smoking in 10 to20 cigarettes every day in restenosis group(39.68%) is higher than that non-restenosis group(25.5%),and the difference is statistically significant(P = 0.048); the rate of smoking more than 20 cigarettes every day in restenosis group(6.35%) is higher than that non-restenosis group(1.96%),and the difference is statistically significant(P = 0.037). Comparing young and middle-aged group and elderly group by hierarchical comparison of systolic blood pressure results showed: the rate of systolic blood pressure 160 ~ 180 mmhg proportion of patients(28.57%) is higher than that non-restenosis group(23.53%),,and the difference is statistically significant(P =0.029); the rate of systolic blood pressure more than180 mmhg in restenosis group(4.76%)is higher than that non-restenosis group(0),and the difference is statistically significant(P = 0.001).Conclusions:Smoking, hypertension, total cholesterol and low density lipoprotein were independent risk factors of in-stent. Smoking and hypertension were associated with in-stent restenosis in young and middle aged with coronary heart disease,and may be unique risk factor of it. The systolic blood pressure greater than 160 mmHg patients and smoking more than 10 cigarettes every day patients, young and middle aged patients than in the elderly patients the occurrence of ISR.