Predictors of in-stent restenosis in coronary heart disease patients complicating with diabetes mellitus within 2 years after drug-eluting stents implantation / 中华心血管病杂志

ABSTRACT

<p><b>OBJECTIVE</b>To determine predictors for in-stent restenosis (ISR) within 2 years after drug-eluting stent (DES) implantation in coronary heart disease patients complicating with diabetes mellitus and to establish predictive model.</p><p><b>METHODS</b>We retrospectively analyzed clinical data of patients underwent DES implantation in our hospital between January 2005 and December 2012. Using random number generated by SPSS 17.0, a total of 3 073 cases were randomly divided into two cohort, model derivation cohort (MDC) and model validation cohort (MVC). MDC (2 048 cases) was divided into in-stent restenosis (ISR) group and control group. Predictors were identified using univariable and multivariable logistic regression analysis in MDC. Integer point values were assigned to each predictor based upon their β coefficient in multivariable logistic regression model to establish scoring model. The summed scores of each case in MVC (1 025 cases) were calculated to test predictive ability of the model.</p><p><b>RESULTS</b>Of all these 3 073 cases, 217 cases (7.1%) were diagnosed with ISR within 2 year after DES implantation. The incidence of ISR within 2 year after DES implantation was 7.3% (149 cases) in MDC and logistic regression analysis identified six ISR risk factors multiple target vessels (OR = 3.69, 95%CI 2.65-8.93, P = 0.000), diffused lesions (OR = 2.92, 95%CI 2.03-6.46, P = 0.000), GFR < 60 ml×min(-1)·1.73 m(-2) (OR = 4.73, 95%CI 3.51-10.62, P = 0.000), smoking (OR = 3.37, 95%CI 2.39-8.46, P = 0.000), age < 60 years old (OR = 1.44, 95%CI1.26-4.63, P = 0.024), HbAlc ≥ 6.3% (OR = 2.48, 95%CI 1.84-4.27, P = 0.002). Risk score was well associated with the rate of ISR in MVC. Sensitivity was 76.5% (95%CI 64.6%-85.9%), specificity was 76.1% (95%CI 73.2%-78.7%), and areas under the ROC curve was 0.851(95%CI0.813-0.890, P = 0.000) when score was set at 5.5.</p><p><b>CONCLUSIONS</b>The incidence of ISR in coronary heart disease patients complicating with diabetes mellitus within 2 years after DES implantation is relatively low. Several factors are associated with ISR in these patients and risk for ISR could be reliably identified by the established scoring model.</p>