Analysis of risk factors for in-stent restenosis in patients with coronary heart disease after PCI

This study aims to investigate the incidence and risk factors of in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD) and establish a predictive model for early identification and risk stratification of ISR. A retrospective cohort study was conducted on 120 CHD patients who underwent PCI and completed follow-up at our hospital between January 2022 and December 2024 (data cutoff: December 31, 2024). Patients were divided into an ISR group (n = 45, ISR ≥ 50% by CAG or coronary CT at 12 months) and a non-ISR group (n = 75, ISR < 50%). Clinical characteristics, laboratory indicators, coronary lesion morphology, and PCI procedural data were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for ISR. Using receiver operating characteristic curve analysis. Kaplan–Meier survival analysis was applied to assess ISR-free survival between risk groups. There were no significant differences in gender, age, or other basic characteristics between the 2 groups ( P > .05). However, body mass index, diabetes, hypertension, and smoking were more common in the ISR group ( P < .05). Lesion complexity was also greater, with higher rates of multi-vessel disease (MVD), longer lesion length, smaller vessel diameter, and more bifurcation lesions ( P < .05). Multivariate logistic regression identified diabetes mellitus (odds ratio (OR) = 3.50, 95% confidence interval (CI): 1.80–6.80), MVD (OR = 2.80, 95% CI: 1.50–5.20), lesion length (OR = 1.30, 95% CI: 1.10–1.55), post-procedure thrombolysis in myocardial infarction flow ≤2 (OR = 4.20, 95% CI: 1.90–9.30), residual stenosis (OR = 1.25, 95% CI: 1.15–1.40), intraoperative complications (OR = 3.60, 95% CI: 1.70–7.60), high-sensitivity C-reactive protein (OR = 1.40, 95% CI: 1.10–1.75), and neutrophil-to-lymphocyte ratio (OR = 1.90, 95% CI: 1.30–2.80) as independent predictors of ISR. The model showed good discrimination (AUC = 0.841, 95% CI: 0.770–0.905), with 82.2% sensitivity and 74.7% specificity. Kaplan–Meier analysis demonstrated significantly lower ISR-free survival in the high-risk group ( P < .001). Diabetes, complex coronary lesions, suboptimal procedural outcomes, inflammation, and metabolic abnormalities are independent predictors of ISR after PCI. The established predictive model offers effective risk stratification, providing a basis for individualized management strategies to improve long-term outcomes in CHD patients.