The Analysis Of Risk Factors In The Case Of Coronary Artery In-Stent Restenosis And The Curative Effect In The Treatment Of Coronary Artery In-Stent Restenosis In A Long-Term Clinical Follow-Up

PartⅠThe analysis of risk factors in the case of coronary artery in-stent restenosisObjective:The objective of the study was to analyse the rick factors in the case of coronary artery in-stent restenosis(ISR).Methods:We studied the relationship between ISR and factors influencing clinical features and coronary angiographic characteristics by means of univariate analysis and logistic regression analysis in 205 specimens from patients with non-ISR(n=36) and patients with ISR(n=169)[occlusion lesion group(n=25) and non-occlusion lesion group(n=143) according to the severity of ISR lesion;typeⅠ(n=17),typeⅡ(n=111),typeⅢ(n=15) and typeⅣ(n=25) according to Mehran classification.(one case was excluded because of insufficient information)].Results.In 205 specimens,univariate analysis showed①the proportion of need for insulin therapy among diabetic patients,long vessel lesion and multivessel coronary disease were higher in ISR group versus non-ISR group(P=0.047/0.027/＜0.001);②the proportion of need for insulin therapy among diabetic patients and degree of previously stenosis lesion were higher in occlusive lesion group versus non-occlusive lesion group(P=0.024/0.013);③the proportion of need for insulin therapy among diabetic patients and bifurcative vessel lesion were higher in severe type(according to Mehran classification)(P=0.040/0.001);however,logistic regression analysis revealed that there was negative correlation between multivessel coronary disease and ISR(OR=33.409).Conclusions:Multivessel coronary disease is the independent risk factor of ISR.The need for insulin therapy among diabetic patients and long vessel lesion are probably linked to ISR;the need for insulin therapy among diabetic patients and degree of previously stenosis lesion are probably linked to occlusive ISR;the need for insulin therapy among diabetic patients and bifurcative vessel lesion are probably linked to high risk type according to Mehran classification. PartⅡThe curative effect in the treatment of coronary artery in-stent restenosis in a long-term clinical follow-upObjective:The objective of the study was to compare the curative effect difference among the treatment of ISR with stent,balloon angioplasty(BA),coronary artery by pass graft surgery(CABG) and drug therapy.Methods:In this part,we collected 169 specimens with ISR.These patients were followed for up to about 28 months after the treatment of ISR.We observered major adverse cardiac events(MACE) from patients with the treatment of BA(n=70), CABG.(n=15),drug therapy(n=14) and stent(n=70).We also divided these specimens into LAD group(n=34),LCX group(n=4) and RCA group(n=25) according to stent localization(4 cases were excluded because of other localization).and 133 of those(36 cases were excluded because of insufficient information)into＜3mm group(n=48) and≥3mm group(n=85) according to lesion vessel diameter.Results:The overall MACE rate of 169 patients with ISR was 43.20%and the curative effect of non-LAD lesion was better than LAD leision after an average 28.37-month follow-up,although the complications during hospital stay and MACE were similar among stent group,BA group,CABG group and drug group.The outcome was the same in the subgroup analysis(classified according to stent localization and lesion vessel diameter).Conclusions:The long term curative effect of non-LAD lesion is better than that of LAD lesion,although there was no correlation between the long-term curative effect in the treatment of ISR and factors influencing the different means of therapy.The outcome was the same in the subgroup analysis(classified according to stent localization and lesion vessel diameter) though it may influenced by the severity of former leision. PartⅢThe curative effect of durg eluting stent(DES) implantation in the treatment of coronary artery in-stent restenosis in a long-term clinical follow-upObjective:The objective of the study was to evaluate the curative effect of DES implantation in the treatment of ISR.Methods:63 patients were followed for up to about 25 months after the DES implantation in the treatment of ISR.We observed MACE by dividing these patients into LAD group(n=34),LCX group(n=4) and RCA group(n=25) according to stent localization;paclitaxel group(n=18),rapamycin group(n=44) and tacrolimus group(n=1) according to the eluting material;typeⅠ(n=2),typeⅡ(n=47),typeⅢ(n=8) and typeⅣ(n=5) according to Mehran classification(one case was excluded because of insufficient information);＜3mm group(n=15) and≥3mm group(n=45) according to lesion vessel diameter(3 cases were excluded because of insufficient information); post-DES ISR group(n=15) and post-BMS ISR group(n=48) according to the type of former stent implantation.Results:The MACE rate of these patients was 46.51%and no in-stent thrombosis event or myocardial infraction(MI) event occured during an average 25.70-month follow-up.Further investigition showed the curative effect of non-LAD lesion was better than LAD leision.And the no target vessel revascularization(TVR) survival time in＜3mm group was shorter than that in≥3mm group according to lesion vessel diameter,but there was no statistical difference between them(P=0.065).The result of subgroup analysis also revealed there was no correlation between the long-term curative effect after DES implantation in the treatment of ISR and factors influencing the severity of lesion,the drug eluting material or the type of former stent implantation.Conclusions:DES implantation is a safety and useful method in the treatment of ISR.And the curative effect of non-LAD ISR is better than LAD leision after a long term clinical follow up and there was no correlation between the long-term curative effect after DES implantation in the treatment of ISR and factors influencing the severity of lesion or the drug eluting material or the type of former stent implantation. However,our study shows whether the treatment of post-DES restenosis is suboptimal warrants further investigation.