Development of a Risk Stratification Model for Coronary In-Stent Restenosis Based on Clinical, Laboratory, and...

Area of Science:

• Cardiology
• Medical Technology
• Public Health

Background:

• Coronary in-stent restenosis (ISR) is a significant complication of drug-eluting stent (DES) placement during percutaneous coronary intervention (PCI), impacting long-term patient prognosis.
• Existing prediction models for ISR often utilize invasive procedural data and are primarily developed in high-income populations, limiting their broad applicability.
• There is a need for a generalized risk stratification model for ISR based on routinely accessible patient information.

Purpose of the Study:

• To identify independent predictors of coronary ISR in a diverse patient cohort from Kazakhstan.
• To develop and internally validate a clinically applicable risk stratification model for ISR.
• To utilize routinely available clinical, laboratory, and procedural factors for risk assessment.

Main Methods:

• A retrospective case-control study involving 910 patients who underwent coronary angiography post-PCI.
• Comparison of 455 patients with confirmed ISR against 455 patients without ISR.
• Multivariable binary logistic regression for identifying independent predictors; ROC analysis and bootstrap resampling for model validation.

Main Results:

• Independent predictors of ISR included prior myocardial infarction (MI), type 2 diabetes mellitus (T2DM), and smoking.
• Patients with ISR exhibited poorer inflammatory and metabolic profiles (higher NLR, MHR, atherogenic index, TyG index) and lower LVEF.
• A developed risk model incorporating T2DM, stent number, MPV, neutrophil count, HDL-C, and LVEF showed good discrimination (AUC 0.828) and 74.4% accuracy.

Conclusions:

• The developed risk stratification model demonstrates good discrimination and satisfactory internal validity.
• The model serves as a potentially valuable tool for assessing patient risk of ISR following PCI.
• External validation in independent cohorts is recommended prior to widespread clinical implementation.