Evaluation of Preprocedural Laboratory Parameters as Predictors of Drug-Eluting Stent Restenosis in Coronary Chronic Total Occlusion Lesions

Abstract

This retrospective, single-center study assessed the prognostic value of several emerging inflammatory markers as predictors of in-stent restenosis (ISR) after drug-eluting stent implantation for coronary chronic total occlusion (CTO) lesions. Consecutive patients (n = 416) who underwent successful percutaneous coronary intervention (PCI) for documented CTO lesions and with follow-up angiography were enrolled. Preprocedural high-sensitivity C-reactive protein (hsCRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) were analyzed. At mean follow-up of 14.4 ± 3.3 months, ISR occurred in 72 patients. Compared with the non-ISR group, preprocedural hsCRP level, PLR, NLR, and RDW were significantly higher in the ISR group. The ISR group also had significantly greater proportions of patients with diabetes and smoking history, lower estimated glomerular filtration rate, higher low-density lipoprotein cholesterol (LDL-C) level and neutrophil count, longer stent length, and higher rate of severe dissection. In multivariate analysis, NLR (odds ratio [OR]: 3.110; 95% confidence interval [CI], 2.102-4.063; P < .001) and PLR (OR: 1.029; 95% CI, 1.016-1.143; P < .001) were independent predictors of ISR, along with LDL-C level and stent length. In conclusion, higher preprocedural NLR and PLR levels were independent risk factors for the development of ISR in patients who underwent PCI for CTO lesions.

Response to the Letter to the Editor “The Relationship Between Neutrophil–Lymphocyte Ratio and In-Stent Restenosis”

“…C-reactive protein (CRP) is a widely used index of inflammation, and many studies show its associations with restenosis. 7 As shown in our study, the relationship between NLR and CRP was analyzed, and a positive correlation was found. 13 Diabetes and hyperlipidemia are known risk factors for atherosclerosis and restenosis.…”

“…3,4 Many studies have shown its association with many cardiovascular diseases, 5,6 including stent restenosis. [7][8][9] However, the NLR is not specific, affected by the state of inflammation in the body, such as chronic obstructive pulmonary disease, 10 liver cirrhosis, and gastric ulcer. 11,12 We agree with the comment that other inflammatory diseases should be identified.…”

Impact of Neutrophil-Lymphocyte Ratio on Long-term Outcomes of Patients with Coronary Chronic Total Occlusion After Percutaneous Coronary Intervention

“…Indeed, in ammation plays an indispensable role in the pathogenesis of atherosclerosis, and an elevation in in ammatory biomarkers represents the activation of coronary artery damage [14]. Mounting evidence suggests that in ammation, including pre-existing systemic in ammation, local vascular in ammation secondary to PCI, plays a central role in promoting neointimal growth and in-stent restenosis [16,22].…”

“…Total white blood cells, neutrophil, lymphocyte, and platelet counts, RDW, MPV were calculated using an automated blood cell counter (Model XE2100; Sysmex, Kobe, Japan). The NLR was computed using the absolute neutrophil count divided by the lymphocyte count, the PLR was calculated by dividing the platelet count by the absolute lymphocyte count [16].…”

“…More recently, it has been demonstrated that NLR level is associated with the prevalence and severity of CAD, and the elevated NLR predicts the risk of adverse cardiac events in acute coronary syndrome patients [14,15]. Additionally, higher baseline NLR level was risk factor for the development of in-stent restenosis in CTO patients after PCI [16].…”