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Published on: May 14, 2013
Retrospective Cohort Study: Nomogram for 1-Year in-Stent Restenosis After PCI in Coronary Heart Disease
Xin-Fu Cao1, Dao-Hai Chen1, Ya-Li Qiu2
1Department of Cardiology, Changzhou Affiliated Hospital of Nanjing University of Chinese Medicine, Changzhou, Jiangsu, People's Republic of China.
Insights
This study developed a nomogram to predict in-stent restenosis (ISR) after coronary artery stenting. Key risk factors include diabetes, high neutrophil/lymphocyte ratio, elevated LDL, calcified lesions, small stent diameter, smoking, and lack of intravascular ultrasound assistance.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Informatics
Background:
- In-stent restenosis (ISR) is a significant complication following percutaneous coronary intervention (PCI) for coronary heart disease (CHD).
- Accurate risk prediction is crucial for optimizing patient management and preventing ISR.
Purpose of the Study:
- To develop and validate a nomogram for predicting the risk of ISR within one year after PCI in CHD patients.
- To identify independent predictors of ISR to aid in clinical decision-making.
Main Methods:
- A cohort of 842 severe CHD patients undergoing PCI was analyzed.
- Risk factors were identified using LASSO and multivariate logistic regression.
- A nomogram was constructed and validated using bootstrap resampling, ROC analysis, calibration curves, and decision curve analysis (DCA).
Main Results:
- Seven independent risk factors for ISR were identified: diabetes, neutrophil/lymphocyte ratio (NLR), low-density lipoprotein (LDL) > 1.8 mmol/L, calcified lesions, stent diameter < 3 mm, smoking, and absence of intravascular ultrasound (IVUS) assistance.
- The nomogram demonstrated excellent discriminative ability (AUC = 0.892) and predictive accuracy (C-index = 0.923).
- The model showed strong clinical utility, with calcified lesions, stent diameter < 3 mm, and no IVUS assistance being the most influential factors.
Conclusions:
- The developed nomogram effectively predicts the risk of ISR in CHD patients post-PCI.
- The model possesses good predictive efficiency and clinical applicability, aiding in risk stratification and personalized treatment strategies.
Objective:
To construct a nomogram for risk prediction of in-stent restenosis (ISR) within one year after percutaneous coronary intervention (PCI) for coronary heart disease (CHD).
Methods:
This study included 842 patients with severe CHD who underwent PCI at Changzhou Affiliated Hospital of Nanjing University of Chinese Medicine between March 2016 to March 2024. Based on the occurrence of ISR within one year post-PCI, patients were stratified into two groups: the ISR group (n=112) and the non-ISR group (n=730). Potential risk factors were initially identified using LASSO regression, followed by multivariate logistic regression to determine independent predictors. A nomogram prediction model was developed using R software (version 4.2.6) and internally validated via the bootstrap resampling method (1000 iterations). Model performance was assessed through receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA).
Results:
This analysis revealed seven risk factors for ISR: diabetes (OR=1.380, 95% CI: 1.090-1.747), neutrophil/lymphocyte ratio (NLR, OR=2.312, 95% CI: 1.830-2.922), low-density lipoprotein (LDL) > 1.8 mmol/L (OR=2.159, 95% CI: 1.080-4.315), calcified lesions (OR=3.780, 95% CI: 2.051-6.968), stent diameter <3 mm (OR=2.595, 95% CI: 1.404-4.796), smoking (OR=2.796, 95% CI: 1.511-5.174) and no intravascular ultrasound (IVUS) assisted (OR=2.176, 95% CI: 1.342~3.257). These seven factors were incorporated into the nomogram model. The model demonstrated excellent discriminative ability, with an area under the curve (AUC) of 0.892 (95% CI: 0.859-0.924) and a consistency index (C-index) of 0.923. Calibration analysis showed close agreement between predicted and observed outcomes, while DCA indicated strong clinical utility across a wide probability threshold range (5.0%-86.2%). The relative importance of the risk factors, ranked in descending order, was as follows: calcified lesions, stent diameter <3 mm, no IVUS assisted, LDL>1.8 mmol/L, smoking, NLR and diabetes.
Conclusion:
The study identifies several risk factors for ISR in CHD patients within one year after PCI. The constructed nomogram model has good predictive efficiency and clinical applicability.
