Analysis Of In-stent Restenosis Related Factors After Percutaneous Coronary Intervention

Background:Coronary heart disease(CHD) is currently one of the most important diseases threatening human health, according to the World Health Organization(WHO) reported that CHD is the leading cause of death by human. Although percutaneous coronary intervention(PCI) because of its advantages have become the treatment of CHD, but the in stent restenosis(ISR) after PCI has become a greater problem to limit the further development of PCI. Objective: To investigate the related factors of ISR after PCI in patients with CHD to provide some theoretical and practical basis for the prevention and treatment of ISR. Methods: CHD patients examined by coronary angiography(CAG) and undergone PCI and accepted review of CAG at 8-12 months after PCI in Zunyi Medical College affiliated hospital from January 2013 to December 2015 were enrolled and divided into ISR group and the non-ISR group according to the results of CAG review. And the data including case characteristics, clinical indicators, data related to the operation, coronary vessels characteristics, drug use, and major adverse cardiovascular events were collected and analyzed. Results: A total of 588 patients with an average of 62.26±10.10 years were included in the study. All patients, 41 cases ISR occurred, and the incidence of ISR is 7.0%. The most common site of ISR is the coronary artery right coronary artery(RCA), and the II type is the most common type, according to Mehran type. The more results as follows: 1) the general clinical data, there were no significant differences in drinking history, gender, age in ISR group when compared with non ISR group(P > 0.05), and there was statistically significant difference in hypertension, diabetes, smoking history, family history of coronary heart disease between ISR group and non ISR group(P < 0.05); 2)there were no significant difference in sub-type of coronary heart disease and emergency operation or not between ISR group and non ISR group(P > 0.05); 3) the related clinical indicators, there was statistically significant difference in total bilirubin, uric acid, TC, LDL-C, LP(a), fibrinogen, blood sugar between ISR group and non ISR group(P < 0.05), while there were no significant difference in TG, HDL-C, LP(b), left atrial diameter, left ventricular diameter and left ventricular ejection fraction(P > 0.05); 4) the characteristics of coronary artery, there were no significant difference in average number of coronary, lesions site, the number of vascular lesions, lesion length, preoperative stenosis degree, Gensini score(P > 0.05), while there was statistically significant difference in myocardial bridge between ISR group and non ISR group(P < 0.05); 5) stent characteristics, there were no statistical significance in the number of implanted stents, stent length, stent diameter, pre-expansion an pro-expansion between ISR group and non ISR group(P > 0.05), while there are statistically significant difference in stent diameter over 3mm, residual stenosis post-operation between the two groups(P < 0.05); 6) there was significant difference in regular use of double resistance and statins between two groups(P < 0.05); while there was no significant difference in the regular use of ACEI or ARB, the occurrence of symptoms of chest pain, beta blockers between ISR group and non ISR group(P > 0.05); 7) adverse cardiovascular events, there were not acute myocardial infarction or cardiac death during follow-up both ISR group and non ISR group, and there are no significant difference in arrhythmia, heart failure symptoms in between two groups(P > 0.05); 8) a multi factor analysis, logistic regression analysis shows that the diabetes, uric acid, and myocardial bridge are positive correlation with ISR(P < 0.05), and total bilirubin, implanted stent diameter( over3 mm or not) are negative correlation with ISR(P < 0.05). Conclusion: 1.Smoking, hypertension, diabetes, family history of coronary heart disease, high uric acid, TC, LDL-C, LP(a), Fib, fasting glucose, postoperative residual stenosis, combination of myocardial bridge, not regular taking double resistance as well as stains may be risk factors of ISR; 2.The total bilirubin, stent diameter ≥3mm ISR may be a protective factor of ISR; 3. The occurrence of ISR may have no correlation with the type of CHD, and the location of target vessel, lesion type, emergency PCI or not, stent length, stent overlap or not, balloon dilation, etc.