The Associate Between Platelet To Lymphocyte Ratio And In-stent Restenosis In Patients With Coronary Chronic Total Occlusions And Diabetes Mellitus

BackgroundAs the constant improvement of citizens’ lives,coronary artery disease has become one of the most common chronic diseases,bringing huge challenges to people’s health,and the treatment and prevention of coronary artery disease is urgent.Percutaneous coronary intervention(PCI)is a safe and effective treatment method,Chronic total occlusions(CTO)is one of the fortresses of interventional treatment for coronary artery disease.It is a huge challenge for the surgeon and the patients.However,with the improvement of surgeon’s technology,the latest CTO PCI equipment and technology improvements,including hybridization technology(forward and reverse technology,wire upgrade and subintimal reentry true lumen technology)can achieve a higher surgical success rate while maintaining low complications incidence rate.CTO refers to the total occlusion of coronary arteries,the forward TIMI blood flow is Grade 0,and the occlusion duration is≥3 months.Approximately 16%to 52%of patients undergoing diagnostic coronary angiography(CAG)have observed this phenomenon.Diabetes mellitus is also relatively common in patients with CTO(about 30-40%),CTO patients with diabetes mellitus usually have a long occlusion segment and complex lesions,which makes it difficult to open.Diabetes mellitus also has an adverse effect on the development of collateral circulation and microcirculation in CTO patients.Therefore,diabetes mellitus is an important risk factor for CTO patients,and it should be taken into consideration when determining the treatment plan.All of the above shows that the study of special populations such as CTO with diabetes mellitus has positive significance.Studies have confirmed that,compared with CTO lesions that have failed to prescribe or have only medical therapy(medical therapy,MT),successful revascularization of CTO lesions is significantly related to the improvement of patients’ symptoms,quality of life and left ventricular function.In-stents restenosis(ISR)is one of the important complications after PCI,and the incidence is 3%-20%.With the rapid development of interventional technology and the widespread application of drug-eluting stents(DES),the incidence of ISR is gradually decreasing.However,the ISR of CTO lesions still occurs at a relatively high rate,about 10%-15%.Recent studies have found that platelet to lymphocyte ratio(PLR),as an easily available and inexpensive inflammatory parameter,is a major predictor of adverse outcomes for various cardiovascular diseases,and it is also a significant factor for complex coronary artery disease in patients.Studies have reported the correlation between PLR and ISR after PCI,but there are few studies on the correlation between PLR and ISR after PCI in special patients such as CTO with diabetes mellitus.ObjectiveThe aim is to explore the associate between the platelet to lymphocyte ratio and in-stent restenosis in patients with coronary chronic total occlusion and diabetes mellitus after PCI.MethodsA retrospective analysis of 264 patients who underwent CAG in cardiovascular department of the First Affiliated Hospital of Zhengzhou University from December 2016 to December 2019,confirmed that main coronary artery was CTO and successfully underwent PCI,including 171 males and 93 females.The CAG was reviewed in our hospital 6 months or more after surgery.According to the results,they were divided into ISR group(75 cases)and non-ISR group(169 cases).The general information,serological and echocardiographic indexes,CAG and PCI processes of the two groups were compared.Using binary multivariate logistic regression analysis to explore the relevant risk factors of ISR in patients with CTO and diabetes mellitus after PCI,through receiver operating characteristic curve and area under the curve to analyze the value of PLR in predicting ISR.Results1.The age,platelets,HbAlc,PLR,neutrophil to lymphocyte ratio,D-dimer,family history of coronary heart disease and the proportion of multivessel disease in the ISR group were higher than those in the non-ISR group,while the lymphocytes were lower than those in the non-ISR group.There were statistical differences((P<0.05)).The remaining baseline data and clinical indicators were not statistically different between the two groups of patients.2.Binary multivariate logistic regression analysis showed that PLR increased(OR=1.032,95%CI:1.018-1.047,P<0.001),HbA1c increased(OR=1.319,95%CI:1.037-1.678,P=0.024),a family history of coronary heart disease(OR=2.704,95%CI:1.288-5.679,P=0.009),older age(OR=1.058,95%CI:1.020-1.097,P=0.003)are independent risk factors for ISR in patients with coronary chronic total occlusion and diabetes mellitus after PCI.3.The ROC curve shows that the area under the curve for PLR to predict ISR with coronary chronic total occlusion and diabetes mellitus after PCI is 0.788(95%CI:0.728-0.848,P<0.001),the best cut-off point for prediction is 138.33,the sensitivity is 67.11%,and the specificity is 80.47%.ConclusionsPLR is closely related to the occurrence of ISR in CTO patients with diabetes after PCI,and is an independent risk factor for ISR.PLR,as an easily available and cheap inflammatory index,has high predictive value for ISR after PCI,and can provide a basis for identifying the occurrence of ISR after PCI in this population.