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Vol. 33. Issue 4.
Pages 184-194 (July - August 2021)
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Vol. 33. Issue 4.
Pages 184-194 (July - August 2021)
Original article
DOI: 10.1016/j.artere.2021.07.005
Predictor of in-stent restenosis in patients with drug-eluting stent (PRIDE)- a retrospective cohort study
Predictor de reestenosis intrastent en pacientes con El stent liberador de drogas (PRIDE), un estudio de cohorte retrospective
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Praveen K. Gupta
Corresponding author
praveenkumargupta2002@gmail.com

Corresponding author.
, Jayaram Balachander
Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Tables (6)
Table 1. Clinical and angiographic characteristics of the study population.
Table 2. Laboratory profile of patients at the time of stenting.
Table 3. Treatment received by the patient at the time of stenting.
Table 4. Procedural characteristics of the study population.
Table 5. Follow up data of the study population.
Table 6. Univariate analysis of study population for the development of ISR.
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Abstract
Background

It is a fact that coronary artery disease (CAD) is more prevalent in India as compared to western countries. The major risk factors associated with the early CAD are a high prevalence of diabetes mellitus, atherogenic lipid profile, smoking habits, sedentary lifestyle, low socioeconomic condition and high prevalence of obesity. Is this true for restenosis after drug-eluting stent (DES) implantation and factors associated with it? The main objective of the study was to determine the rate of in-stent restenosis (ISR) in patients with DES and risk factors associated with it from our region.

Methods

It was a single-center, retrospective cohort study in which 550 patients who underwent DES implantation were included. Patient's demographic data, coronary angiography findings, procedural characteristics and development of ISR were noted.

Results

Out of 550 patients, 31 developed ISR with a rate of restenosis of 5.63% and target lesion revascularization (TLR) of 5.63%. On multiple Cox-regression analysis, only diabetes mellitus (DM) (p=0.008, adjusted hazard ratio (HR): 2.757, 95% confidence interval (CI): 1.296–5.863), deployment of stent in the left anterior descending (LAD) artery (p=0.031, adjusted HR: 3.342, 95% CI: 1.115–10.017) and periprocedural complication during percutaneous coronary intervention (p=0.040, adjusted HR: 2.824, 95% CI: 1.049–7.603) were found to be significantly associated with increased risk of ISR. Kaplan–Meier survival analysis of event-free survival for restenosis showed patients with DM had significantly lower event-free survival compared to patients without DM (p=0.005 by log-rank test).

Conclusions

In our study, the rate of restenosis after DES implantation was 5.63%. The presence of DM, the stent in the LAD territory and the periprocedural complication is strongly associated with the development of ISR.

Keywords:
Drug-eluting stent
Diabetes mellitus
In-stent restenosis
Stent thrombosis
Young coronary artery disease
India
Retrospective cohort study
Resumen
Antecedentes

Es un hecho que la enfermedad de las arterias coronarias (EAC) es más frecuente en la India que en los países occidentales. Los principales factores de riesgo relacionados con la EAC temprana son una alta prevalencia de la diabetes mellitus, el perfil lipídico aterogénico, el hábito de fumar, el sedentarismo, la baja condición socioeconómica y la alta prevalencia de la obesidad. ¿Es esto cierto para la reestenosis después de la implantación de un stent liberador de fármacos (DES) y los factores asociados a ella? El principal objetivo del El estudio fue determinar la tasa de reestenosis intrastent (ISR) en pacientes con DES y los factores de riesgo asociados a ella de nuestra población.

Métodos

Fue un estudio de cohorte retrospectivo de un solo centro en el que se incluyeron 550 pacientes que se sometieron a la implantación de DES. Se anotaron los datos demográficos del paciente, los hallazgos de la angiografía coronaria, las características del procedimiento y el desarrollo del ISR.

Resultados

De 550 pacientes, 31 desarrollaron ISR con una tasa de reestenosis del 5,63% y una revascularización de la lesión diana (TLR) del 5,63%. En el análisis de regresión de Cox múltiple, sólo la diabetes mellitus (p = 0,008, cociente de riesgo ajustado (CRI): 2,757, intervalo de confianza (IC) del 95%: 1,296-5,863), el despliegue de la endoprótesis en la arteria descendente anterior izquierda (LAD) (p = 0,031, CRI ajustado: 3. 342, IC del 95%: 1.115-10.017) y la complicación periprocedimental durante la intervención coronaria percutánea (p = 0.040, CRI ajustado: 2.824, IC del 95%: 1.049-7.603) se encontraron significativamente asociadas con el aumento del riesgo de ISR. El análisis de Kaplan---Meier de supervivencia libre de eventos para la reestenosis mostró que los pacientes con diabetes mellitus (DM) tenían una supervivencia libre de eventos significativamente menor en comparación con los pacientes sin DM (p = 0,005 por prueba de rango logarítmico).

Conclusiones

En nuestro estudio, la tasa de reestenosis tras la implantación del DES fue del 5,63%. La presencia de DM, el stent en el territorio del LAD y la complicación periprocedimental está fuertemente asociada con el desarrollo del ISR.

Palabras clave:
Un stent liberador de drogas
Diabetes mellitus
Reestenosis en el stent
Trombosis del stent
Arteria coronaria joven enfermedad
India
Cohorte retrospective estudio

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