The Risk Factors Analysis Of Long Term In-stent Restenosis After PCI

?Background and Objective?The incidence of coronary heart disease is rising with the rapid development of social economy,and percutaneous coronary intervention(PCI)becomes more mature providing a fast and effective treatment for patients with coronary heart disease especially with drug eluting stent(DES)by which the rate of in stent restenosis(ISR)and target lesion revascularization(TLR)is significantly reduced.Although the bioresorbable stent(BRS)has become hot,while large scale clinical trials have not conducted clear results.So DES will be widely used in the treatment of coronary heart disease in the future for a long period time.However,as is reported that some patients with DES implantation have received repeated revascularization even under standard drug therapy after operation,especially rare for the factors for late revascularization.The risk factors for target lesion revascularization(TLR)are mainly due to in stent restenosis(ISR)and stent thrombosis(ST).In recent years,late ISR(>1year after stenting)catch our attention.With the increase of the number of interventional treatment,the incidence of late stent failure also increased year by year.A retrospective case-control study is conducted to explore the risk factors for late target lesion revascularization in order to recognize the risk factors,optimize treatment strategies,and provide the basis for improving the prognosis of patients.?Methods?286 patients were admitted to the research and followed up by coronary arteriongraphy(CAG)who have underwent PCI for 1 year at least in cardiology department in The First Affiliated Hospital of Dalian Medical University in 201401-2015 12.The patients were divded into group A(CAG group n=137),group B(ISR group n=149).The differences of clinical data,data in CAG and PCI,polymer coating types,antiproliferative drugs between two groups of A and B were retrospectivelyanalyzed.?Results?1.In CAG group(group A)and ISR group(group B): LDL-C(2.05±0.62vs2.33±0.90,P=0.019),is significantly different;LP(a)(139.85±115.18vs205.66±225.85,P=0.026),is significantly different;diabetes mellitus(36.5%vs50.3%,P=0.018),is significantly different;2.In CAG group(group A)and ISR group(group B):multi vessel lesions(45.3%vs71.8,P < 0.001),is significantly different;bifurcation lesions(5.0%vs19.7%,P = 0.000),is significantly different;antiproliferative drug(paclitaxel)(20.0% vs 31.8%,P=0.011)is significantly different;stent diameter,stent length and CTO have no significant difference.3.In ISR group(group B),ISR in non polymer coated stent mainly comes in 1-2years after stenting,which is earlier compared with other polyer coated stent.ISR in permaent polymer coated stent mainly comes in 5-10 years after stenting,which is later compared with other polyer coated stent.?Conclusions?1.Diabetes,higher LDL-C and Lp(a)are risk factors for late ISR.2.Bifurcation lesions,multivessel lesion,antiproliferative drug(paclitaxel)in ISR group was significantly higher than CAG group,which need further study.3.ISR in non polymer coated stent comes earlier compared with other polyer coated stent.