Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis
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...
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IMR Press
2024-12-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/25/12/10.31083/j.rcm2512458 |
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| author | Birong Liu Meng Li Jia Liu Lihua Xie Jiaqi Li Yong Liu Chaofeng Niu Di Xiao Jingen Li Lijing Zhang |
| author_facet | Birong Liu Meng Li Jia Liu Lihua Xie Jiaqi Li Yong Liu Chaofeng Niu Di Xiao Jingen Li Lijing Zhang |
| author_sort | Birong Liu |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-2a5c58048508472e9e4123f7fdd16a6f |
| institution | DOAJ |
| issn | 1530-6550 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj-art-2a5c58048508472e9e4123f7fdd16a6f2025-08-20T02:39:51ZengIMR PressReviews in Cardiovascular Medicine1530-65502024-12-01251245810.31083/j.rcm2512458S1530-6550(24)01543-6Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-AnalysisBirong Liu0Meng Li1Jia Liu2Lihua Xie3Jiaqi Li4Yong Liu5Chaofeng Niu6Di Xiao7Jingen Li8Lijing Zhang9Department of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, ChinaDepartment of Cardiovascular Medicine, Xi’an Hospital of Traditional Chinese Medicine, 710001 Xi'an, Shaanxi, ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, ChinaDepartment of Cardiovascular Medicine, Dongfang Hospital, Beijing University of Chinese Medicine, 100078 Beijing, ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, ChinaDepartment of Cardiovascular Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, ChinaBackground: 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.https://www.imrpress.com/journal/RCM/25/12/10.31083/j.rcm2512458drug-eluting stentin-stent restenosisincidencerisk factorsmeta-analysis |
| spellingShingle | Birong Liu Meng Li Jia Liu Lihua Xie Jiaqi Li Yong Liu Chaofeng Niu Di Xiao Jingen Li Lijing Zhang Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis Reviews in Cardiovascular Medicine drug-eluting stent in-stent restenosis incidence risk factors meta-analysis |
| title | Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis |
| title_full | Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis |
| title_fullStr | Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis |
| title_short | Risk Factors and Incidence for In-Stent Restenosis with Drug-Eluting Stent: A Systematic Review and Meta-Analysis |
| title_sort | risk factors and incidence for in stent restenosis with drug eluting stent a systematic review and meta analysis |
| topic | drug-eluting stent in-stent restenosis incidence risk factors meta-analysis |
| url | https://www.imrpress.com/journal/RCM/25/12/10.31083/j.rcm2512458 |
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