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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Do pre-procedural laboratory parameters predict drug-eluting stent restenosis?
Aslı Tanındı1, Berkay Ekici2, Hasan Fehmi Töre2
1Department of Cardiology, Ufuk University Faculty of Medicine, Ankara, Turkey. aslitanindi@gmail.com.
Insights
Pre-procedural blood markers do not predict in-stent restenosis (ISR) in drug-eluting stents (DES). Diabetes and residual stenosis after the procedure are the main predictors of ISR in patients with stable coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Drug-eluting stents (DES) have significantly reduced in-stent restenosis (ISR) rates.
- Previous studies identified pre-procedural laboratory markers as predictors of ISR with bare metal stents.
- The predictive value of these markers for ISR with DES remains to be fully elucidated.
Purpose of the Study:
- To investigate whether pre-procedural laboratory parameters predict ISR in patients undergoing DES implantation for stable coronary artery disease.
- To identify independent predictors of ISR in the context of DES implantation.
Main Methods:
- Retrospective analysis of 315 stents in 285 patients who underwent coronary stenting and follow-up angiography within one year.
- Recording of pre-procedural complete blood count, biochemistry, and C-reactive protein (CRP).
- Quantitative coronary angiography analysis to assess ISR.
Main Results:
- The overall restenosis rate was 10.2%.
- Higher rates of diabetes and smoking were observed in the ISR group.
- While CRP levels were significantly higher in the ISR group, other tested markers (N/L ratio, RDW, UA, MPV) showed no significant difference. Multivariate analysis identified diabetes mellitus (DM) and post-procedural residual stenosis as the only independent predictors of ISR.
Conclusions:
- Pre-procedural blood parameters do not independently predict ISR in patients treated with DES.
- Diabetes mellitus and the degree of residual stenosis post-procedure are the primary determinants of ISR in DES implantation.
- These findings suggest a shift in the understanding of ISR predictors with the advent of DES technology.
Objective:
Drug-eluting stents (DES) have considerably reduced the rates of in-stent restenosis (ISR). Several studies reported pre-procedural C-reactive protein (CRP), neutrophil to lymphocyte (N/L) ratio, red cell distribution width (RDW), serum uric acid (UA), and mean platelet volume (MPV) as independent predictors of ISR using bare metal stents. This study investigates whether any laboratory parameter obtained before the coronary stenting procedure is associated with ISR using DES in stable coronary artery disease.
Methods:
Three hundred fifteen stents were retrospectively analysed in 285 patients who had undergone coronary stenting and a control coronary angiography within one year of stenting, between January 2012 and April 2014. Pre-procedural complete blood count, biochemistry, and CRP were recorded. Off-line quantitative coronary angiography analysis was performed.
Results:
Overall restenosis rate was 10.2%. When the stents were analysed with respect to the presence of ISR, the number of diabetics and smokers was higher in the ISR group. CRP levels were significantly higher in the ISR group, but there were no differences in N/L, monocytes, eosinophils, RDW, MPV, UA, and total bilirubin levels. In the univariate regression analysis, DM, CRP, stent length, stent diameter, pre-procedural diameter stenosis, pre-procedural minimal lumen diameter (MLD), post-procedural residual diameter stenosis, post-procedural reference vessel diameter, and post-procedural MLD were predictors of ISR. However, multivariate regression analysis identified only DM and post-procedural residual stenosis as independent predictors of ISR.
Conclusion:
Pre-procedural blood parameters do not independently predict ISR in DES, which is mainly determined by the presence of diabetes and post-procedural residual stenosis.
