Combined predictive value of vascular endothelial growth factor, stent diameter and stent length for in-stent restenosis

  AIM  To explore the combined predictive value of vascular endothelial growth factor (VEGF), stent diameter and stent length for in-stent restenosis (ISR) patients after drug-eluting stent (DES) implantation.

  METHODS  From June 2014 to August 2016, 332 patients with unstable angina (UA) who underwent drug-eluting stent implantation in the Department of Cardiology, Chengde Central Hospital were selected for the study, including 178 males and 154 females. The patients were divided into ISR group (n= 41) and non-ISR group (n=291) according to the results of coronary angiography reexamination at 1 year after operation. General clinical data and coronary stent operation data of the two groups were compared. The serum VEGF levels of the patients before, 6 months and 12 months after coronary stent implantation were measured by enzyme-linked immunosorbent assay (ELISA) and the difference of VEGF expression between the two groups was compared.

  RESULTS  There was no significant difference in VEGF level between ISR group and non-ISR group before operation (499±39) ng/L vs. (503±35) ng/L. The VEGF level in ISR group was significantly lower than that in non-ISR group after operation (377±33 ng/L vs. (462±55) ng/L; (184±34) ng/L vs. (361±45)ng/L and the difference had statistical significance (all P<0.01). The results of logistic regression analysis showed that postoperative VEGF level was a protective factor for ISR (OR=0.95, 95% CI: 0.92-0.97, P<0.01). Type II diabetes mellitus (OR=14.81, 95% CI: 1.96-111.81, P<0.01) and heavy smoking after operation (OR=32.74, 95% CI: 4.74-226.03, P<0.01) were closely related to ISR, which were independent risk factors for ISR. Stent length (OR=1.26, 95% CI: 1.09-1.46, P<0.01) was positively correlated with ISR, and stent diameter (OR=0.03, 95% CI: 0.00-0.23; P<0.01) was inversely related to ISR. The ROC curve of the combined indexes of VEGF, stent diameter and stent length showed that VEGF had good predictive value for ISR. However, the combined indexes were better than a single predictive factor, including stent diameter, stent length and VEGF.

  CONCLUSION  Postoperative VEGF level is closely related to ISR, which is an independent predictor of ISR and can be used as an indicator for clinical assessment of in-stent restenosis in coronary artery. The combined indexes of VEGF, stent diameter and stent length are of the best efficiency in predicting ISR efficiency.