Inverse Relationship between Serum VEGF Levels and Late In-Stent Restenosis of Drug-Eluting Stents

Late in-stent restenosis (ISR) has raised concerns regarding the long-term efficacy of drug-eluting stents (DES). The role of vascular endothelial growth factor (VEGF) in the pathological process of ISR is controversial. This retrospective study aimed to investigate the relationship between serum VEGF levels and late ISR in patients with DES implantation. A total of 158 patients who underwent angiography follow-up beyond 1 year after intervention were included. The study population was classified into ISR and non-ISR groups. The ISR group was further divided according to follow-up duration and Mehran classification. VEGF levels were significantly lower in the ISR group than in the non-ISR group [96.34 (48.18, 174.14) versus 179.14 (93.59, 307.74) pg/mL, p<0.0001]. Multivariate regression revealed that VEGF level, procedure age, and low-density lipoprotein cholesterol were independent risk factors for late ISR formation. Subgroup analysis demonstrated that VEGF levels were even lower in the very late (≥5 years) and diffuse ISR group (Mehran patterns II, III, and IV) than in the late ISR group (1–4 years) and the focal ISR group (Mehran pattern I), respectively. Furthermore, significant difference was found between diffuse and focal ISR groups. Serum VEGF levels were inversely associated with late ISR after DES implantation.

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Drug-Eluting Balloons versus Second-Generation Drug-Eluting Stents for Treating In-Stent Restenosis in Coronary Heart Disease after PCI: A Meta-Analysis

Cardiology Research and Practice ◽

10.1155/2018/7658145 ◽

2018 ◽

Vol 2018 ◽

pp. 1-14 ◽

Cited By ~ 2

Author(s):

Wen-Juan Xiu ◽

Hai-Tao Yang ◽

Ying-Ying Zheng ◽

Yi-Tong Ma ◽

Xiang Xie

Keyword(s):

Observational Studies ◽

Second Generation ◽

Meta Analysis ◽

Drug Eluting Stents ◽

Randomized Controlled ◽

Stent Restenosis ◽

Significant Difference ◽

Drug Eluting ◽

In Stent Restenosis

Background. In-stent restenosis (ISR) remains a common problem following percutaneous coronary intervention (PCI). However, the best treatment strategy remains uncertain. There is some controversy over the efficacy of drug-eluting balloons (DEBs) and second-generation drug-eluting stents (DESs) for treating ISR. Methods. A meta-analysis was used to compare the efficacy of the DEB and second-generation DES in the treatment of ISR. The primary endpoint is the incidence of target lesion revascularization (TLR). The secondary endpoint is the occurrence of target vessel revascularization (TVR), myocardial infarction (MI), all-cause death (ACM), cardiac death (CD), major adverse cardiac events (MACEs), minimum luminal diameter (MLD), late luminal loss (LLL), binary restenosis (BR), and percent diameter stenosis (DS%). Results. A total of 12 studies (4 randomized controlled trials and 8 observational studies) including 2020 patients with a follow-up of 6–25 months were included in the present study. There was a significant difference in the MLD between the two groups during follow-up (P=0.007, RR = 0.23, and 95% CI: 0.06–0.4 mm). There was no significant difference in LLL, BR, or DS% and the overall incidence of MACEs between the two groups. Subgroup analysis showed no significant difference in the incidence of primary and secondary endpoints when considering RCTs or observational studies only. Conclusions. The efficacy of the DEB and second-generation DES in the treatment of ISR is comparable. However, our results need further verification through multicenter randomized controlled trials.

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A prediction model based on platelet parameters, lipid levels, and angiographic characteristics to predict in-stent restenosis in coronary artery disease patients implanted with drug-eluting stents

Lipids in Health and Disease ◽

10.1186/s12944-021-01553-2 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Min-Tao Gai ◽

Bing Zhu ◽

Xiao-Cui Chen ◽

Fen Liu ◽

Xiang Xie ◽

...

Keyword(s):

Prediction Model ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Coronary Intervention ◽

Drug Eluting Stents ◽

Distribution Width ◽

Model Based ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

Abstract Background The present study was aimed to establish a prediction model for in-stent restenosis (ISR) in subjects who had undergone percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). Materials and methods A retrospective cohort study was conducted. From September 2010 to September 2013, we included 968 subjects who had received coronary follow-up angiography after primary PCI. The logistic regression analysis, receiver operator characteristic (ROC) analysis, nomogram analysis, Hosmer–Lemeshow χ2 statistic, and calibration curve were applied to build and evaluate the prediction model. Results Fifty-six patients (5.79%) occurred ISR. The platelet distribution width (PDW), total cholesterol (TC), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and lesion vessels had significant differences between ISR and non-ISR groups (all P < 0.05). And these variables were independently associated with ISR (all P < 0.05). Furthermore, they were identified as predictors (all AUC > 0.5 and P < 0.05) to establish a prediction model. The prediction model showed a good value of area under curve (AUC) (95%CI): 0.72 (0.64–0.80), and its optimized cut-off was 6.39 with 71% sensitivity and 65% specificity to predict ISR. Conclusion The incidence of ISR is 5.79% in CAD patients with DES implantation in the Xinjiang population, China. The prediction model based on PDW, SBP, TC, LDL-C, and lesion vessels was an effective model to predict ISR in CAD patients with DESs implantation.

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The incidence of in-stent restenosis after drug-eluting stent implantation in patients on chronic hemodialysis

10.21203/rs.3.rs-29228/v1 ◽

2020 ◽

Author(s):

Masayuki Motohiro ◽

Hiroshi Sugita ◽

Hiroki Shibutani ◽

Syun Morishita ◽

Masami Tanaka ◽

...

Keyword(s):

Stent Implantation ◽

Second Generation ◽

Chronic Hemodialysis ◽

Rotational Atherectomy ◽

Drug Eluting Stents ◽

Drug Eluting Stent ◽

Stent Restenosis ◽

Significant Difference ◽

Drug Eluting ◽

In Stent Restenosis

Abstract Background: Recently, drug-eluting stents have been widely adopted rather than bare-metal stents in patients on chronic hemodialysis (HD) based on the extrapolation of data from patients on non-HD. However, whether DES implantation is associated with a reduced rate of in-stent restenosis (ISR) is unclear. We investigated the incidence of ISR and its predictors in patients on HD after drug-eluting stent implantation.Methods and Results: We analyzed 194 consecutive patients (331 lesions) on HD who underwent follow-up angiography after drug-eluting stent implantation. ISR was observed in 74 lesions (22.4%). Angiographically, the relative incidence of AHA/ACC type C lesion was increased (47% vs. 32%; P=0.043), the minimal lumen diameter (MLD) before DES implantation was smaller (0.82±0.49 vs. 0.97±0.45mm; P<0.01) and the lesion length (LL) was increased (30.2±16.1 vs. 24.4±12.1mm; P=0.023) in lesions with ISR compared to those without ISR. The rate of rotational atherectomy use was also increased in lesions with ISR compared to those without ISR (50% vs. 25%; P<0.01). In a multivariate analysis, the MLD before drug-eluting stent implantation (odds ratio [OR] =0.50, 95% confidence interval [CI] 0.27-0.91, P=0.024), LL (OR=1.02, 95% CI 1.00-1.04, P=0.030) and the use of rotational atherectomy (OR=2.71, 95% CI 1.55-4.72, P<0.01) were independent predictors of ISR. The incidence of ISR was similar between lesions treated with the first-generation (25.8%) and the second-generation DESs (20.4%).Conclusion: ISR was observed in 74 lesions (22.4%). A small MLD, long LL and the use of rotational atherectomy were independent predictors of ISR after drug-eluting stent implantation in patients on HD. There was no significant difference in ISR rate between the first- and the second-generation drug-eluting stents.

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Elevated levels of very low-density lipoprotein cholesterol independently associated with in-stent restenosis in diabetic patients after drug-eluting stent implantation

Chinese Medical Journal ◽

10.4103/0366-6999.213575 ◽

2017 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Yu-Jie Zhou ◽

Zheng Qin ◽

Fang-Wu Zheng ◽

Chuang Zeng ◽

Kuo Zhou ◽

...

Keyword(s):

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Drug Eluting Stent ◽

Diabetic Patients ◽

Very Low Density Lipoprotein ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Stent Restenosis ◽

Drug Eluting ◽

In Stent Restenosis

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Comparison of new-generation drug-eluting stents versus drug-coated balloon for in-stent restenosis: a meta-analysis of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2017-017231 ◽

2018 ◽

Vol 8 (2) ◽

pp. e017231 ◽

Cited By ~ 8

Author(s):

Jin-Zan Cai ◽

Yong-Xiang Zhu ◽

Xin-Yu Wang ◽

Christos V Bourantas ◽

Javaid Iqbal ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Death ◽

Meta Analysis ◽

Drug Eluting Stents ◽

Stent Restenosis ◽

Drug Eluting ◽

New Generation ◽

Drug Coated Balloon ◽

In Stent Restenosis

ObjectiveThe study sought to compare angiographic and clinical outcomes of new-generation drug-eluting stents (DES) versus drug-coated balloon (DCB) in patients with coronary in-stent restenosis (ISR).DesignMeta-analysis using data from randomised trial found by searches on PubMed, the Cochrane Library, ClinicalTrials.gov and websites of major cardiovascular congresses.SettingOnly randomised trials comparing DES with DCB were included.ParticipantsPatients with ISR in the included trials.InterventionsNew-generation DES versus DCB.OutcomesThe angiographic and clinical outcomes including cardiac death, all-cause death, myocardial infarction, target lesion revascularisation (TLR), target vessel revascularisation (TVR), major adverse cardiac events (MACE) and stent thrombosis were investigated.ResultsFive trials including 913 patients were eligible and included. Pooled analysis in angiographic results identified that new-generation DES were associated with higher acute luminal gain (−0.31 mm, 95% CI −0.42 to −0.20, P<0.001) and lower per cent diameter stenosis (risk ratio (RR): 0.28, 95% CI 0.02 to 0.55, P=0.04). DES significantly reduced the risk of TLR (RR: 1.96, 95% CI 1.17 to 3.28, P=0.01) compared with DCB; however, there was no statistical differences for MACE (RR: 1.21, 95% CI 0.67 to 2.17, P=0.53), myocardial infarction (RR: 1.16, 95% CI 0.55 to 2.48, P=0.69) and cardiac death (RR: 1.80, 95% CI 0.60 to 5.39, P=0.29).ConclusionsInterventions with new-generation DES appear to be associated with significant reduction in per cent diameter stenosis and TLR at short-term follow-up, but had similar MACE, myocardial infarction and cardiac death for patients with coronary ISR compared with DCB. Appropriately powered studies with longer term follow-up are warranted to confirm these findings.

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The Predictors of Target Lesion Revascularization and Rate of In-Stent Restenosis in the Second-Generation Drug-Eluting Stent Era

Journal of Interventional Cardiology ◽

10.1155/2019/3270132 ◽

2019 ◽

Vol 2019 ◽

pp. 1-13

Author(s):

Chengbin Zheng ◽

Jeehoon Kang ◽

Kyung Woo Park ◽

Jung-Kyu Han ◽

Han-Mo Yang ◽

...

Keyword(s):

Target Lesion ◽

University Hospital ◽

Target Lesion Revascularization ◽

Drug Eluting Stent ◽

2Nd Generation ◽

Stent Restenosis ◽

Significant Difference ◽

Drug Eluting ◽

In Stent Restenosis

Objectives. The aim of our study was to investigate the predictors of target lesion revascularization (TLR) and to compare the in-stent restenosis (ISR) progression rates of different 2nd-generation drug-eluting stents (DES). Background. The predictors of early and late TLR after 2nd-generation DES implantation have not been fully evaluated. Methods. We analyzed 944 stented lesions from 394 patients who had at least two serial follow-up angiograms, using quantitative coronary angiography (QCA) analysis. The study endpoints were TLR and the velocity of diameter stenosis (DS) progression. Results. TLR occurred in 58 lesions (6.1%) during the first angiographic follow-up period and 23 de novo lesions (2.4%) during the following second interval. Independent predictors for early TLR were diabetes mellitus (DM) (HR 2.58, 95% CI 1.29–5.15, p=0.007), previous percutaneous coronary intervention (PCI) (HR 2.41, 95% CI 1.03–5.65, p=0.043), and postprocedure DS% (HR 1.08, 95% CI 1.05–1.11, p<0.001, per 1%), while predictors of late TLR were previous PCI (HR 9.43, 95% CI 2.58-34.52, p=0.001) and serum C-reactive protein (CRP) (HR 1.60, 95% CI 1.28-2.00, p<0.001). The ISR progression velocity (by DS%) was 12.1 ±21.0%/year and 3.7 ±10.1%/year during the first and second follow-up periods, respectively, which had no significant difference (p>0.05) between the four types of DESs. Conclusions. Our data showed that predictors for TLR may be different at different time intervals. DM, pervious PCI, and postprocedure DS could predict early TLR, while previous PCI and CRP level could predict late TLR. Contemporary DESs had similar rates of ISR progression rates. Trial Registration. This study was retrospectively registered and approved by the institutional review board of Seoul National University Hospital (no. 1801–138-918).

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Occurrence and predictive risk factors associated with in-stent restenosis after drug-eluting stent implantation in diabetic patients: a prospective, clinical cohort study

10.21203/rs.3.rs-26601/v1 ◽

2020 ◽

Author(s):

ShengGang Zhao ◽

Jian-Jiang Xu ◽

Li-Qin Jiang ◽

Zhen-Liang Chu ◽

An-Qian Tao ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Density Lipoprotein ◽

Inflammatory Factors ◽

Drug Eluting Stent ◽

Stent Restenosis ◽

Dynamic Observation ◽

Drug Eluting ◽

In Stent Restenosis

Abstract Background The incidence of in-stent restenosis (ISR) in patients with diabetes mellitus (DM) after percutaneous coronary intervention (PCI) is significantly higher than that in patients without DM, but the mechanism is not clear. We hypothesised that patients with and risk factors including dyslipidaemia, elevated inflammatory factors would be prone to induction of ISR, and that dynamic observation of the comprehensive risk factor changes before and after PCI would be helpful to identify ISR . Methods This prospective cohort study consecutively enrolled 360 patients who received coronary drug-eluting stent implantation. Patients who underwent coronary angiography (CAG) and received clinical follow-up were prospectively reviewed. The patients were assigned to a DM (262) or a non-DM (98) group. The patients were further assigned according to whether ISR was present to the non-DM + non-ISR, non-DM + ISR, DM + non-ISR, and DM + ISR groups. The patients were further assigned according to whether low-density lipoprotein (LDL-c) was decreased more than 50% compared with baseline, or was less than 1.80 mmol/L in the follow-up, to the LDL-c achieved or the LDL-c failure groups. Results DM patients were prone to develop ISR after PCI and the degree of coronary stenosis was more severe than in non-DM patients. This result was more striking in DM and LDL-c failure patients. The levels of total cholesterol (TC), triglyceride, high-density lipoprotein (HDL-c), LDL-c, apolipoprotein B100, apolipoprotein E, remnant lipoprotein, TC/HDL-c ratio and triglyceride/HDL-c ratio in the DM + non-ISR were similar to those in the DM + ISR group before PCI and CAG. .The DM + ISR group had the highest levels of haemoglobin A1c and the highest Gensini scores. The inflammatory index changes including leukocytes and neutrophils were the most striking in the DM + ISR group. In multivariate regression analysis, neutrophil changes and glycosylated haemoglobin were independent risk factors for ISR [△neutrophil, OR 1.929,95% CI 1.216–3.058; HbA1-c OR 1.559,95% CI 1.001–1.707]. Conclusion Coronary artery disease patients with DM had a high risk for ISR if they had preoperative risk factors including dyslipidaemia, elevated inflammatory factors, and a high Gensini score. Dynamic observation of the changes of the preoperative and postoperative comprehensive risk factors was helpful to identify ISR in patients with DM.

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