Correlation Between Lymphocyte/monocyte Ratio And Drugeluting Stents' In-stent Restenosis In Patients With Unstable Angina Pectoris

Objective:To study the correlation and Predictive value between lymphocyte/monocyte ratio(LMR)and drug-eluting stents'(DES)in-stent restenosis(ISR)in patients with unstable angina pectoris.Methods:By using the inclusion and exclusion criteria established in this study,a retrospective analysis of patients with unstable angina pectoris and a history of coronary drug-coated stent implantation from January 2014 to October 2019 in the Department of Cardiovascular Medicine of Subei people's Hospital had been made,Finally,231 patients who met the study requirements were included.According to the results of coronary angiography,the 231 patients and 358 stents were divided into ISR group and non-ISR group.All patients were asked for detailed medical history after admission to obtain basic clinical data.All patients were drawn for fasting blood early in the morning before coronary angiography to obtain their relevant serological tests.All patients had completed coronary angiography,and their coronary angiography results were evaluated by 2 qualified cardiovascular intervention experts.By using Visual inspection,At least a vessel of 3 main coronary arteries(left anterior descending artery,left circumflex artery,or right coronary artery)or its main branch with a stenosis of 50% or more can be assessd as the presence of ISR.At the same time,the number of restenosis stents and the tandem between two or more stents were observed and recorded.All statistical analyses were performed by using SPSS V.22.0 statistical software package.The receiver operating characteristic curve(ROC)of LMR for predicting the occurrence of ISR in the patients of the study was drawn,and the area under the curve and the Jordan index were calculated.All test methods were statistically significant with P <0.05.Results:Coronary angiography's results of 231 patients showed that there were 112 patients in the ISR group and 119 patients in the non-ISR group;ISR was present in 172 stents in the ISR group and 186 stents in the non-ISR group.Age,smoking and patient with diabetes were statistically significant between the ISR group and the non-ISR group(P<0.05);while the rest of the basic clinical data were not statistically significant between the ISR group and the non-ISR group(P> 0.05).Lymphocyte count,monocyte count,uric acid,LMR,and neutrophil/lymphocyte ratio(NLR)were statistically significant between the the ISR group and the non-ISR group(P<0.05);The rest of the serological indicators didn't have statistical significance between the ISR group and the non-ISR group(P>0.05).There was a statistically significant difference in the total number of stent implants between the ISR group and the non-ISR group(P<0.05).The Spearman correlation test showed that there was a positive correlation between the total number of stent implantations and the presence of ISR in patients(r = 0.235,P<0.05);The time interval between stent implantation and review angiography(<1 year,?1 year)and the number of diseased vessels(single,double,and triple)didn't have statistically significant difference between the ISR group and the non-ISR group(P> 0.05).There were statistically significant differences between the ISR group and the non-ISR group in the number of stent tandems and the length of the implanted stent(P<0.05).The Spearman correlation test showed that there was a positive correlation between the number of stent tandems and implanted stents with ISR(r = 0.111,P<0.05);There was no statistically significant difference in the coronary artery sites of stent implantation(left anterior descending branch,left circumflex branch,and right coronary artery)and the diameter of the implanted stent between the ISR group and the non-ISR group(P> 0.05).The factors in which the study object was a patient or a stent tested by single factor analyses showing P <0.05 were included in the binary multivariate logistic regression analysis model.The results showed that: diabetes(OR: 2.275,95% CI: 1.167?4.435;P=0.016),uric acid(OR: 1.004,95% CI: 1.000?1.008;P=0.045),LMR(OR: 0.355,95% CI: 0.151?0.834;P=0.018),the total number of stent implants ? 3(OR : 4.075,95% CI: 1.765?9.407;P=0.001)were independent risk factors for the presence of ISR in patients;3 stents in series(OR: 2.960,95% CI: 1.104?7.934;P=0.031)and The length of the implanted stent(OR: 1.040,95% CI: 1.008?1.073;P=0.014)were independent risk factor for implanted stent with ISR;the ROC curve was plotted,and the results showed that LMR predicts the most likely ISR in patients with unstable angina pectoris.The cutoff value was 4.23,sensitivity was 70.5%,specificity was 66.5%,AUC = 0.720(95% CI: 0.655?0.785;P <0.001).Conclusion:1.Increase in age,smoking,monocyte count,uric acid and decreased lymphocytes may promote drug-eluting stents with ISR in patients with unstable angina pectoris.2.Increase in the length of the stent or the number of stents in series is related to the occurrence of ISR in DES.The number of stents in series is positively related to the occurrence of ISR in DES.The length of the stent and the number of stents in series(3 stents in series)are independent risk factors that cause ISR in DES.3.Diabetes,increased uric acid,and increased total numbers of stent implantation are related to the presence of DESs' ISR in patients with unstable angina pectoris.The total numbers of stent implantation is positively correlated with the presence of DESs' ISR in study patients.Diabetes,uric acid,The total numbers of stent implantation(?3 stents)are independent risk factors for DESs' ISR in patients with unstable angina pectoris;4.Reduced LMR is related to the presence of DESs' ISR in patients with unstable angina pectoris and is the independent risk factor of it.LMR <4.23 indicates that the risk of DESs' ISR in the study's patients is significantly increased.