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<p>In-stent restenosis (ISR) remains a major stent failure post-PCI. This study aimed to explore the predictive capability of pre-PCI baseline angiographically-derived radial wall strain (RWS) for the development of ISR in self-controlled patients. In this retrospective self-controlled study, we included 64 patients (146 stented lesions) with multivessel PCI in whom at least one vessel developed ISR and at least one remained free of ISR, allowing within-patient comparison. Pre-PCI baseline RWS was measured for all stented lesions in each patient. Lesion-level maximal RWS (RWS<sub>max</sub>) was defined as the highest RWS in the stenotic segment. The incremental discriminant and reclassification abilities for ISR prediction were compared between 2 models (Model 1: Angiography Characteristics + Stent Characteristics; Model 2: Model 1 + RWS<sub>max</sub>). Among all lesions, 76 (52.1%) lesions developed ISR (ISR group), while 70 (47.9%) lesions maintained luminal patency (non-ISR group) over a median follow-up duration of 21 months (IQR: 13.0–39.3). The baseline RWS<sub>max</sub> was significantly higher in the ISR group compared to the non-ISR group (15.0% vs. 12.4%, <i>P</i> &lt; 0.001). RWS<sub>max</sub> demonstrated a strong predictive value for ISR, with an area under the curve (AUC) of 0.82 (95% CI: 0.75–0.88, <i>P</i> &lt; 0.001) and an optimal cutoff of &gt; 14.5%. RWS<sub>max</sub> &gt;14.5% was independently associated with increased risk of ISR, with an odds ratio of 8.74 (95% CI: 6.73–24.52, <i>P</i> &lt; 0.001). Compared with Model 1, Model 2 exhibited superior discriminative ability (C-index: 0.852 vs. 0.713; <i>P</i> &lt; 0.001) and higher reclassification ability (NRI: 0.471, <i>P</i> &lt; 0.001; relative IDI: 0.347; <i>P</i> = 0.018) for predicting ISR. In this retrospective, self-controlled study, baseline angiographically-derived RWS is a reliable, independent biomechanical marker that can effectively predict the risk of ISR.</p> Graphical abstract <p>Predictive ability of Baseline Angiographically derived RWS for ISR among self-controlled patients. RWS<sub>max</sub> was signifcantly associated with increasing rates of ISR after PCI with an optimal cut-off value of &gt; 14.5%. The addition of RWS provided incremental value in prediction for future ISR compared to the current state of the traditional prediction model for ISR including angiography and stent characteristics</p> <p></p>

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The association between angiographically derived radial wall strain and the risk of in-stent restenosis

  • 期刊论文

  • 发表日期：

    2025年10月17日

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  • Fang Zhang,
  • Wei Gao,
  • Fan Fan,
  • Jinying Zhou,
  • Jingpu Wang,
  • Rende Xu,
  • Leilei Ma,
  • Jiatian Cao,
  • Zhangwei Chen,
  • Yizhe Wu,
  • Zhiqing Wang,
  • Juying Qian,
  • Shengxian Tu,
  • Chenguang Li,
  • Junbo Ge

摘要

In-stent restenosis (ISR) remains a major stent failure post-PCI. This study aimed to explore the predictive capability of pre-PCI baseline angiographically-derived radial wall strain (RWS) for the development of ISR in self-controlled patients. In this retrospective self-controlled study, we included 64 patients (146 stented lesions) with multivessel PCI in whom at least one vessel developed ISR and at least one remained free of ISR, allowing within-patient comparison. Pre-PCI baseline RWS was measured for all stented lesions in each patient. Lesion-level maximal RWS (RWSmax) was defined as the highest RWS in the stenotic segment. The incremental discriminant and reclassification abilities for ISR prediction were compared between 2 models (Model 1: Angiography Characteristics + Stent Characteristics; Model 2: Model 1 + RWSmax). Among all lesions, 76 (52.1%) lesions developed ISR (ISR group), while 70 (47.9%) lesions maintained luminal patency (non-ISR group) over a median follow-up duration of 21 months (IQR: 13.0–39.3). The baseline RWSmax was significantly higher in the ISR group compared to the non-ISR group (15.0% vs. 12.4%, P < 0.001). RWSmax demonstrated a strong predictive value for ISR, with an area under the curve (AUC) of 0.82 (95% CI: 0.75–0.88, P < 0.001) and an optimal cutoff of > 14.5%. RWSmax >14.5% was independently associated with increased risk of ISR, with an odds ratio of 8.74 (95% CI: 6.73–24.52, P < 0.001). Compared with Model 1, Model 2 exhibited superior discriminative ability (C-index: 0.852 vs. 0.713; P < 0.001) and higher reclassification ability (NRI: 0.471, P < 0.001; relative IDI: 0.347; P = 0.018) for predicting ISR. In this retrospective, self-controlled study, baseline angiographically-derived RWS is a reliable, independent biomechanical marker that can effectively predict the risk of ISR.

Graphical abstract

Predictive ability of Baseline Angiographically derived RWS for ISR among self-controlled patients. RWSmax was signifcantly associated with increasing rates of ISR after PCI with an optimal cut-off value of > 14.5%. The addition of RWS provided incremental value in prediction for future ISR compared to the current state of the traditional prediction model for ISR including angiography and stent characteristics