Page 100 - GTM-3-4

Global Translational Medicine Prediction of in-stent restenosis

represents the standardized mortality rate and remains 2. Methods
high in the Russian Federation (590.9 in men and 576.3
in women). For comparison, the standardized mortality 2.1. Systematic analysis
rate for cancer was 397.4 in 2021. However, over the past In the first stage, we performed a systematic analysis of
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20 years in Russia, CVD mortality has decreased by 30% available sources to identify restenosis predictors using data
since 2003. The availability of high-tech interventions from Russian and foreign publications. The search criteria
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continues to grow, with the number of percutaneous included scientific papers published not earlier than 2002
coronary interventions, including primary procedures, that covered analysis of risk factors for coronary in-stent
increased more than 20 times, contributing to a decrease in restenosis, as well as long-term outcomes, endpoints, and
CVD mortality. It is also crucial to address the risk factors, survival rates of patients after stenting, based on the type
which can be classified as non-modifiable (male sex, age, of stent coating (bare metal stent [BMS] or drug-eluting
and burdened family history) and modifiable. Risk factors, stent [DES]). A mandatory selection criterion was the
such as obesity, diabetes mellitus (DM), hypertension, availability of literature information on the risk ratio of
dyslipidemia, alcohol abuse, and smoking, are well- in-stent restenosis or data for calculating the corresponding
studied and modifiable. However, current knowledge risk ratio. We used PubMed and eLibrary to search for
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of risk factors allows for the prediction of CHD in only the articles. The keywords included “in-stent restenosis,”
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50% of cases. Likewise, even when these risk factors are “clinical presentation,” “outcome,” “bare metal stent,”
addressed, the disease often progresses, and acute CHD “drug-eluting stent,” “target lesion revascularization,”
continues to develop and relapse. “myocardial infarction,” and “percutaneous coronary
In addition, successful surgical treatment and adequate intervention.” The search used OR and AND operators.
medical therapy do not guarantee protection from acute The meta-analysis included cohort and case–control
CHD recurrence, as one in five patients with acute coronary studies, both prospective and retrospective. These studies
syndrome develops a recurrent event within 3 years of the evaluated predictors of restenosis, such as smoking,
intervention. 8 DM, arterial hypertension, dyslipidemia, chronic kidney
disease (CKD), dialysis, previous myocardial infarction,
Since the introduction of coronary angioplasty some chronic heart failure, respiratory failure, cerebrovascular
40 years ago, late stent thrombosis, in-stent restenosis, and disease, and Leriche syndrome. In addition, clinical
de novo neo-atherosclerosis have been recognized as major manifestations of in-stent restenosis were evaluated (stable
causes of disease recurrence in long-term prognosis. In angina, unstable angina, and myocardial infarction), and
almost 50% of cases, re-stenosis of a previously implanted endpoints were assessed depending on stent coating. The
stent results in unstable angina pectoris, with 18.7% endpoints were hospitalization, repeat revascularization,
of patients developing non-ST-elevation myocardial myocardial infarction, stent thrombosis, and death. The
infarction (NSTEMI) and 8.5% of patients developing Preferred Reporting Items for Systematic Reviews and
ST-elevation myocardial infarction (STEMI). 9 Meta-Analyses (PRISMA) protocol was used for the search

In-stent restenosis is defined as the re-narrowing of procedure.
a vessel lumen diameter after percutaneous coronary 2.2. Retrospective analysis
intervention. Angiographically, it is identified as recurrent
diameter stenosis >50% at the stent segment or its edges In the second stage, we analyzed 15,000 medical records
(5-mm segments adjacent to the stent). Restenosis results of stented patients from 2015 to 2020 (Figure 1) in a single
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from vascular injury due to balloon inflation and stent center (Republican Cardiological Center, Ufa, Russia).
implantation. Inflammation that occurs in response to Survival status and the occurrence of coronary restenosis
mechanical stretch, endothelial exposure, and subintimal were recorded using the remote data capture system,
hemorrhage plays a key role by triggering a cascade of Program for Medical Cases Monitoring (ProMed), which
proliferative processes. 11,12 In-stent restenosis significantly is used in all the medical institutions in the region.
aggravates the CHD prognosis. Hence, identifying the The inclusion criteria were primary or scheduled
predictors of coronary restenosis is essential for adjusting percutaneous coronary intervention, namely coronary
treatments and improving treatment outcomes. artery stenting. The exclusion criteria were: (i) Patients
The aim of the study was to assess the influence of younger than 18 years of age; (ii) early restenosis or stent
known risk factors in predicting coronary restenosis in thrombosis (up to 30 days of percutaneous coronary
high-risk patients via two stages: (i) systematic analysis intervention); (iii) transplanted heart; (iv) severe renal or
and (ii) retrospective analysis. hepatic insufficiency; (v) severe connective tissue diseases

Volume 3 Issue 4 (2024) 2 doi: 10.36922/gtm.4957