Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis

Birong Liu; Meng Li; Jia Liu; Lihua Xie; Jiaqi Li; Yong Liu; Chaofeng Niu; Di Xiao; Jingen Li; Lijing Zhang

doi:10.31083/j.rcm2512458

Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis

Rev Cardiovasc Med. 2024 Dec 24;25(12):458. doi: 10.31083/j.rcm2512458. eCollection 2024 Dec.

Authors

Birong Liu¹, Meng Li¹, Jia Liu², Lihua Xie¹, Jiaqi Li¹, Yong Liu³, Chaofeng Niu¹, Di Xiao¹, Jingen Li¹, Lijing Zhang¹

Affiliations

¹ Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, China.
² Department of Cardiovascular Medicine, Xi'an Hospital of Traditional Chinese Medicine, 710001 Xi'an, Shaanxi, China.
³ Department of Cardiovascular Medicine, Dongfang Hospital, Beijing University of Chinese Medicine, 100078 Beijing, China.

Abstract

Background: Despite significant reductions in in-stent restenosis (ISR) incidence with the adoption of drug-eluting stents (DES) over bare metal stents (BMS), ISR remains an unresolved issue in the DES era. The risk factors associated with DES-ISR have not been thoroughly analyzed. This meta-analysis aims to identify the key factors and quantify their impact on DES-ISR.

Methods: We conducted comprehensive literature searches in PubMed, EMBASE, Cochrane, and Web of Science up to 28 February 2023, to identify studies reporting risk factors for DES-ISR. Meta-analysis was performed on risk factors reported in two or more studies to determine their overall effect sizes.

Results: From 4357 articles screened, 17 studies were included in our analysis, evaluating twenty-four risk factors for DES-ISR through meta-analysis. The pooled incidence of DES-ISR was approximately 13%, and significant associations were found with seven risk factors. Ranked risk factors included diabetes mellitus (odds ratio [OR]: 1.46; 95% confidence interval [CI]: 1.14-1.87), stent length (OR: 1.026; 95% CI: 1.003-1.050), number of stents (OR: 1.62; 95% CI: 1.11-2.37), involvement of the left anterior descending artery (OR: 1.56; 95% CI: 1.25-1.94), lesion length (OR: 1.016; 95% CI: 1.008-1.024), medical history of myocardial infarction (OR: 1.79; 95% CI: 1.12-2.86) and previous percutaneous coronary intervention (OR: 1.97; 95% CI: 1.53-2.55). Conversely, a higher left ventricular ejection fraction was identified as a protective factor (OR: 0.985; 95% CI: 0.972-0.997).

Conclusions: Despite advancements in stent technology, the incidence of ISR remains a significant clinical challenge. Our findings indicate that patient characteristics, lesion specifics, stent types, and procedural factors all contribute to DES-ISR development. Proactive strategies for early identification and management of these risk factors are essential to minimize the risk of ISR following DES interventions.

The prospero registration: CRD42023427398, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=427398.

Keywords: drug-eluting stent; in-stent restenosis; incidence; meta-analysis; risk factors.

Publication types

Systematic Review

Grants and funding

This research was funded by the Fundamental Research Funds for the Central Universities, Beijing University of Chinese Medicine, grant number 2023-JYB-JBZD-002. It is also supported by the Youth Fund of the National Natural Science Foundation of China, grant number 82004301.