Impact of Arterial Stiffness on In-Stent Restenosis in the Era of Drug-Eluting Stents

Abstract

Background: In the era of drug-eluting stents (DESs), few studies have explored the association between arterial stiffness and the risk of in-stent restenosis (ISR). Methods: Pulse pressure and pulse pressure index (PPI), which are noninvasive measures of arterial stiffness, were measured before percutaneous coronary interventions (PCI). PPI is the ratio of pulse pressure to systolic blood pressure. ISR was defined based on the angiographic evidence of ≥50% stenosis within the previously stented segment. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for ISR. Results: A total of 644 patients were collected, including 72 patients in the ISR group. Pulse pressure and PPI were significantly higher in the ISR group (ISR vs no ISR: pulse pressure, 58.5 ± 16.3 vs 53.1 ± 13.7 mmHg [p = 0.002]; PPI, 0.43 ± 0.07 vs 0.40 ± 0.07 [p = 0.001]). Multivariable-adjusted ORs for ISR, for tertile3 vs. tertile1, were 2.73 (95% CI, 1.33–5.62; p = 0.006) and 2.12 (95% CI, 1.04–4.31; p = 0.038) for pulse pressure and PPI, respectively. The ORs for ISR with a 1-standard deviation (SD) increase in pulse pressure and PPI were 1.41 (95% CI, 1.09–1.83; p = 0.010) and 1.52 (95% CI, 1.15–2.01; p = 0.003), respectively. Conclusions: Arterial stiffness denoted by high pulse pressure and PPI is a predictive factor for ISR. A pre-PCI wide pulse pressure could potentially serve as a marker of risk, as well as a potential target for future therapies. Clinical trial registration: ChiCTR2000039901, https://www.chictr.org.cn/showproj.html?proj=51063.

Keywords

• arterial stiffness
• drug-eluting stents
• in-stent restenosis
• pulse pressure
• pulse pressure index