Inverse Relationship between Serum VEGF Levels and Late In-Stent Restenosis of Drug-Eluting Stents.

Meng Ji,Li Shen,Junbo Ge,Jiasheng Yin,Jiahui Chen,Sishi Cai,Yizhe Wu,Zhifeng Yao

doi:10.1155/2017/8730271

Abstract

Late in-stent restenosis (ISR) has raised concerns regarding the long-term efficacy of drug-eluting stents (DES). The role of vascular endothelial growth factor (VEGF) in the pathological process of ISR is controversial. This retrospective study aimed to investigate the relationship between serum VEGF levels and late ISR in patients with DES implantation. A total of 158 patients who underwent angiography follow-up beyond 1 year after intervention were included. The study population was classified into ISR and non-ISR groups. The ISR group was further divided according to follow-up duration and Mehran classification. VEGF levels were significantly lower in the ISR group than in the non-ISR group [96.34 (48.18, 174.14) versus 179.14 (93.59, 307.74) pg/mL, p < 0.0001]. Multivariate regression revealed that VEGF level, procedure age, and low-density lipoprotein cholesterol were independent risk factors for late ISR formation. Subgroup analysis demonstrated that VEGF levels were even lower in the very late (≥5 years) and diffuse ISR group (Mehran patterns II, III, and IV) than in the late ISR group (1–4 years) and the focal ISR group (Mehran pattern I), respectively. Furthermore, significant difference was found between diffuse and focal ISR groups. Serum VEGF levels were inversely associated with late ISR after DES implantation.

Highlights

The introduction of drug-eluting stents (DES) greatly reduced the incidence of in-stent restenosis (ISR), ISR remains a major complication after stent implantation
Patients with ISR after 1 year were divided into two groups: late ISR (1–4 years: L-ISR) and very late ISR (≥5 years: VL-ISR); the median follow-up interval (5 years) was used to ensure that a comparable number of patients were allocated to each group
There were no significant differences between groups with respect to baseline characteristics including procedural age, gender, history of hypertension or diabetes mellitus, and current smoking status or laboratory values, including total cholesterol (TC), TG, HDL, and LDL levels, but the high-sensitivity C-reactive protein (hs-CRP) level was higher in the ISR group compared to the non-ISR group (p = 0.05)

Summary

Introduction

The introduction of drug-eluting stents (DES) greatly reduced the incidence of in-stent restenosis (ISR), ISR remains a major complication after stent implantation. Recent data have reported that real-world patients with sirolimus-eluting stents have a 10.6% restenosis rate, while the rate of late ISR (defined as restenosis beyond one year) was much higher in patients with first-generation DES than in those with bare metal stents (BMS) [1]. Neoatherosclerosis was more frequently observed after DES implantation than after BMS implantation, especially in patients with late restenosis or thrombosis [2]. These findings suggested that DES restenosis might have a different time course from that of BMS restenosis, which tends to occur within 1 year of implantation. A few studies conducted to date have identified that endothelial dysfunction and consequent neoatherosclerosis play a role in the development of late adverse events [3]

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Results

Conclusion