RIISK FACTORS  FOR IN-STENT RESTENOSIS IN PATIENTS WITH PERCUTANEOUS CORONARY INTERVENTIONS

Zan Zimbakov; Igor Zdravkovski; Emilia Parisko; Silvana Jovanova

Zan Zimbakov University Clinic of Cardiology, Clinical Centre “Mother Theresa”, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R of North Macedonia
Igor Zdravkovski University Clinic of Cardiology, Clinical Centre “Mother Theresa”, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R of North Macedonia
Emilia Parisko Clinical hospital ” Dr.Trifun Panovski”, Bitola R of North Macedonia
Silvana Jovanova University Clinic of Cardiology, Clinical Centre “Mother Theresa”, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R of North Macedonia

Abstract

Percutaneous coronary intervention (PCI) is one of the main treatments for patients with coronary heart disease (CHD), and in-stent restenosis (ISR) after PCI has gradually attracted clinical attention. Although the rates of in-stent restenosis (ISR) have been reduced dramatically with the introduction of drug-eluting stents (DESs), the ISR problem has not been completely resolved. The aim of our study was to identify the risk factors influencing the likelihood of restenosis after stent implantation. We retrospectively review 115 patients (mean age 63.4±0.3years) with previous PCI for acute coronary syndrome or stabile angina pectoris, hospitalized at the University clinic of cardiology in Skopje for follow-up coronary angiography. The data were obtain from coronary intervention database. Seventy two patients were diagnosed as ISR and forty three patients had no significant ISR. Restenosis rates were higher among patients with diabetes mellitus, hiperlipidemia and smoking history and the differences between two groups were statistically significant (all p<0.05). The restenosis rates were higher in patients with BMS compared to first and second generation DESs (p<0.01). The smaller (diameter <3mm) and longer stents (>20mm) were associated with more in-stent restenosis with significant statistical difference among group (p < 0.05). Predictors of in-stent restenosis were identified with linear regression analyses. The diabetes, hyperlipidemia, stent features were independent risk factors for ISR (all p < 0.05). In conclusion, for patients with PCI risk factors identification and management is warranted to prevent the ISR.

Keywords: percutaneous coronary intervention, in-stent restenosis, risk factor

https://doi.org/10.55302/JMS2141150z

References

1.Her AJ and Shin ES. Current Management of In-Stent Restenosis . Korean Circ J. 2018 May;48(5):337-349, https://doi.org/10.4070/kcj.2018.0103.
2.Kokkinidis DG, Waldo SW, Armstrong EJ. Treatment of coronary artery in-stent restenosis. Expert Rev Cardiovasc Ther 2017;15(3):191-202. Doi: 10.1080/14779072.2017.1284588. Epub 2017 Jan 31.
3.Alraies MC, Darmoch F, Tummala, R, Waksman R. Diagnosis and management challenges of in-stent restenosis in coronary arteries.World J Cardiol.2017 Aug 26;9(8):640-651.
4.Kibos A, Campeanu A, Tintoiu I. Pathophysiology of coronary artery in-stent restenosis. Acute Card Care. 2007;9(2):111-9. doi: 10.1080/1748294070126328.
5.Kastrati A, Schomig A, Elezi S, et al. Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol. 1997;30:1428–1436.
6.Cheng G, Chang FJ, Wang Y, You PH et al. Factors influencing stent restenosis after perculatenous coronary intervention in patients with coronary heart disease: A clinical trial based on 1-Year Follow-Up. Med Sci Monit. 2019 Jan 8;25:240-247.doi: 10.12659/MSM.908692.
7.Mercado N, Boersma E, Wijns W, et al. Clinical and quantitative coronary angiographic predictors of coronary restenosis: a comparative analysis from the balloon-to-stent era. J Am Coll Cardiol. 2001;38:645–652.
8.Singh M, Gersh B, McClelland R, at al. Clinical and Angiographic Predictors of Restenosis After Percutaneous Coronary Intervention Insights From the Prevention of Restenosis With Tranilast and Its Outcomes (PRESTO) Trial . Circulation. 2004;109:2727-2731.
9.Magalhaes MA, Minha S, Chen F, Torguson R, Omar AF, Loh JP, et al. Clinical presentation and outcomes of coronary in-stent restenosis across 3-stent generations. Circ Cardiovasc Interv 2014;7:768-76.
10.Jae Young Cho. Identification of Risk Factors Influencing In-Stent Restenosis with Acute Coronary Syndrome Presentation. Chonnam Med J 2017;53:203-210.