Factors affecting in-stent restenosis and the role of flow-mediated dilatation

Objective: In-stent restenosis is a major problem concerning percutaneous coronary interventions. Brachial artery flow-mediated dilation, a non-invasive indicator of endothelial dysfunction, and its relationship with future cardiovascular events is well known.The aim of this study was to identify factors thought to have an effect on in-stent restenosis and to test the predictive value of flow-mediated dilatation.Method: 74 consecutive patients who were treated with bare-metal stents and recommended control coronary angiography during their follow-up were included into the study. Patients were categorized into 2 groups in the form of those having in-stent restenosis (n=35) and no in-stent restenosis (n=39). Clinical, biochemical, angiographic parameters and also flow-mediated dilatation was evaluated.Results: Flow-mediated dilatation was significantly impaired in patients with in-stent restenosis than in patients with no in-stent restenosis (5.1(4.8) % vs. 9.2(4.1) %, p<0.001). After multivariable analysis; flow-mediated dilatation (p=0.004), stent diameter (p=0.014), stent length (p=0.01), no use of statins (p=0.017) and absence of TIMI-3 flow (p=0.039) were found as independent predictors of in-stent restenosis. According to the receiver-operating characteristic curve analysis, optimal cut-off value of flow-mediated dilatation to predict in-stent restenosis was measured to be ≤6.8%, with 75.8% sensitivity and 78.8% specificity (Area under curve 0.764, 95% confidence interval 0.644-0.885).Conclusions: Our study suggested that flow-mediated dilatation may contribute to the identification of high-risk patients who will develop in-stent restenosis after percutaneous coronary interventions.

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