In-stent restenosis in patients with acute coronary syndrome: a case-control analysis of risk factors following drug-eluting stent implantation

Bahareh  Azadmanesh; MirHossein Seyyed  Mohammadzad; Venus Shahabi  Rabori; Negar  Jafari

doi:10.18502/cbj.v5i2.21134

Bahareh Azadmanesh Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
MirHossein Seyyed Mohammadzad Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
Venus Shahabi Rabori Department of Cardiology, Derriford Hospital, Plymouth NHS Trust, UK
Negar Jafari Department of Cardiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

DOI: https://doi.org/10.18502/cbj.v5i2.21134

Keywords: In-stent restenosis; percutaneous coronary intervention; Drug-eluting stent; cardiovascular risk factors; Coronary artery disease

Abstract

Objectives: In-stent restenosis (ISR) remains a significant complication following percutaneous coronary intervention (PCI) with drug-eluting stents (DES), contributing to recurrent cardiovascular events and increased healthcare burden. To assess the occurrence of ISR and identify related risk factors in patients receiving PCI at a tertiary cardiac facility in northwestern Iran.

Methods: The present study is a case-control study involving 593 patients who underwent repeat coronary angiography after prior DES placement between 2020 and 2024 at Seyed ol-Shohadai Hospital in Urmia. The samples consisted of patients in two categories: ISR-positive (n = 209, 35.2%) and ISR-negative (n = 384, 64.8%). The researchers analyzed demographic information, cardiovascular risk factors, laboratory results, and procedural variables between the groups using independent t-tests and chi-square tests.

Results: ISR-positive patients were significantly older (67.61±8.71 vs. 60.13±8.01 years, P=0.03) with a higher prevalence of hypertension (55% vs. 41.4%, P=0.002). Positive C-reactive protein (CRP) was more frequent in ISR patients (63.2% vs. 14.1%, P<0.001). Mean triglyceride (118.48±81.86 vs. 100.95±60.73 mg/dL, P=0.003), LDL-cholesterol (LDL-C) (66.77±30.17 vs. 57.01±19.25 mg/dL, P<0.001), and reduced left ventricular ejection fraction (LVEF) <30% (7.7% vs. 1%, P=0.005) were significantly associated with ISR. Longer intervals between initial and repeat angiography (59.93±38.01 vs. 50.51±32.62 months, P=0.002) and stent length ≥20mm (32.5% vs. 14.3%, P<0.001) increased ISR risk. Everolimus stents showed higher ISR rates compared to sirolimus stents.

Conclusions: Advanced age, hypertension, systemic inflammation, dyslipidemia, impaired ventricular function, longer follow-up intervals, and specific stent characteristics were significantly associated with ISR development in univariate analysis. These findings suggest potential risk factors warranting further investigation through multivariate analysis. Enhanced surveillance and aggressive modification of risk factors in high-risk patients may decrease the incidence of ISR.