| Purpose For patients with acute myocardial infarction,PCI can timely and effectively open the target diseased vessels,which is an effective method to save the ischemic myocardium and prevent further expansion of the lesions.However,in-stent restenosis(ISR)still occurs in 10% of patients after PCI,which seriously affects the prognosis of patients with coronary heart disease,but its specific risk factors remain unclear.The fibrinogen/albumin ratio(FAR)is a novel inflammatory marker,which has been suggested by previous studies to be associated with the prognosis of pancreatic cancer,colorectal cancer,coronary heart disease and other diseases.Some studies suggest that it is related to the occurrence of ISR,but further studies are limited.The purpose of this study was to investigate the risk factors associated with ISR after PCI in acute myocardial infarction,and to provide reference for the prevention of ISR.Method Clinical data of patients who underwent drug-eluting stent implantation(DES-PCI)for the first time due to acute myocardial infarction in the Second Affiliated Hospital of Shenyang Medical College were collected from January 2016 to May 2022 and reexamined by coronary angiography within 6-24 months after surgery with 323 persons and depending on the presence or absence of stenosis within the stent who are divided into ISR group and NISR group according to the results of re-examination coronary angiography.There were 77 patients in the ISR group and 246 patients in the NISR group.Collection of relevant data between the two groups: including 1: General clinical data: age,sex,smoking history,hypertension,diabetes,atrial fibrillation,type of acute myocardial infarction;2: General biochemical data: Including blood routine(red blood cells(RBC),white blood cells(WBC),platelets(PLT),hemoglobin(HB),neutrophils,lymphocytes,monocytes,red blood cell distribution width(RDW),platelet distribution width(PDW)),liver function(Aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL),direct bilirubin(DBIL),albumin(HB)),fibrinogen(FIB),glomerular filtration rate(e GFR),creatinine,blood uric acid,blood lipid((low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),cholesterol(TC),triglyceride(TG)];3: Information related to cardiac ultrasound and coronary angiography,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,left atrial diameter,the time interval with returning hospital for re-examination,multi-vessel lesions,Gensini score,stent implantation site,number of implanted stents,diameter of implanted stents,and length of implanted stents.A database was established,and patients were divided into in-stent restenosis group(ISR)and non-in-stent restenosis group(NISR)according to reexamination angiography to check whether there was in-stent restenosis.Statistical analysis was performed using SPSS 29.0 data software to compare the differences between the two groups.Normal distribution of measurement data toX±S,using test is compared between group;The measurement data of non-normal distribution were expressed by median(interquartile distance),and the comparison between groups was non-parametric test.Count data were expressed as frequency and percentage(%),and components were compared by chi-square test or Fisher exact probability method.Multivariate binary Logistic regression analysis was used to analyze the risk factors of ISR after PCI,and ROC curve analysis was used to draw the predictive value of FAR for ISR.P < 0.05 was considered to be statistically significant.Result 1.Overview of the study population: A total of 323 patients,mean age 62 years,had 123 STEMI and 200 non-ST-segment elevation myocardial infarction.They were divided into two groups according to the presence or absence of ISRs,including 77 in the ISR group and 246 in the NISR group.The comprehensive detection rate of ISR over one years was 23.5% and the comprehensive detection rate of ISR over two years was 23.5%,in which <The detection rate of ISR was 26.5% in patients aged 60 years and 22.3% in patients aged ≥60 years.A total of 618 stents were implanted in 323 patients,one stent in 107 patients,two stents in 138 patients,three stents in 77 patients,and four stents in 1 patient.A total of 78 ISRs occurred in 323 patients,and 2 ISRs occurred in 1 patient.LAD had the most ISRs,with 37 stenosis,accounting for 48.1%.There were 32 strictures in RCA,accounting for 41.6%.LCX had 8 strictures,accounting for 10.4%.2.Comparison of clinical data: there were statistically significant differences between the ISR group and the non-ISR group in diabetes history,atrial fibrillation,and smoking history(P<0.05).There were no significant differences between the two groups in gender,age,history of hypertension,type of myocardial infarction and the time interval with returning hospital for re-examination(P> 0.05).3.Laboratory examination data: there were statistical differences in PDW and FAR between ISR group and NISR group(P<0.05).There was no significant difference in RBC,WBC,PLT,lymphocytes,monocytes,RDW,neutrophils,HB,ALT,AST,TBIL,DBIL,e GFR,uric acid,TC,TG,HDL-C and LDL-C(P>0.05).4.Data related to cardiac color ultrasound and coronary angiography: there were statistically significant differences between the ISR group and the NISR group in multiple stents implantation,minimum stent diameter implantation,right coronary artery disease,and Gensini score(P<0.05).There were no significant differences in left ventricular end diameter,left atrial diameter,LEVF,average length of stent implantation,and whether there were multiple branch lesions,anterior descending branch lesions,and circumflex branch lesions(P>0.05).5.Logistic regression analysis: The factors including history of hypertension,diabetes,PDW,mean stent length,minimum stent diameter and multiple stents implanted and so on were included in the multivariate logistic regression analysis,and the results showed that FAR(P<0.001,95%Cl: 1.203,1.622),minimum stent diameter(P=0.002,95%Cl: 0.105,0.598)and multiple stents implanted(P=0.011,95%Cl: 1.209,4.228)were independent risk factors for predicting ISR.The AUC of ROC curve analysis was 0.673(95%CI: 0.609,0.738,P<0.001),the sensitivity was 88.3%,and the specificity was 59.3%,which had certain diagnostic value.Conclusion 1.The fibrinogen/albumin ratio is closely related to the occurrence of coronary artery stenec restenosis in patients with acute myocardial infarction,and is a risk factor for stenaceous restenosis;2.Fibrinogen/albumin ratio can be used as a predictor of coronary stenosis in patients with acute myocardial infarction. |
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