What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary heart disease with drug-eluting stents (n=644). Intervention: High pulse pressure (Tertile 3) vs. Low pulse pressure (Tertile 1). Primary outcome: In-stent restenosis (≥50% stenosis) (OR 2.73, 95% CI 1.33-5.62, p=0.006).

What does this research mean for the field?

High pulse pressure and pulse pressure index, which indicate arterial stiffness, significantly increase the risk of in-stent restenosis in patients receiving drug-eluting stents. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 19, 2025Open Access

Impact of Arterial Stiffness on In-Stent Restenosis in the Era of Drug-Eluting Stents

Key Result

High pulse pressure significantly increased the risk of in-stent restenosis (OR 2.73) compared to low pulse pressure in patients with coronary heart disease who received drug-eluting stents.

Study Design

Type

Cohort (n=644)

Multicenter

Structured PICO

Does high pre-PCI arterial stiffness (pulse pressure and pulse pressure index) predict in-stent restenosis in patients with coronary heart disease undergoing drug-eluting stent implantation?

Population

644 patients with coronary heart disease (CHD) who underwent drug-eluting stent (DES) implantation and returned for coronary angiography at least 6 months after stent implantation. Mean age 61.9 years, 79% men. Single-center registry in China.

Intervention

High pre-PCI arterial stiffness, measured by pulse pressure (PP) and pulse pressure index (PPI) (highest tertiles)

Comparator

Lower pre-PCI arterial stiffness (lowest tertiles of pulse pressure and pulse pressure index)

Outcome

In-stent restenosis (ISR), defined as angiographic evidence of ≥50% stenosis within the previously stented segmentsurrogate

Pre-procedural wide pulse pressure and high pulse pressure index are independent predictors of in-stent restenosis in patients receiving drug-eluting stents.

Main Result

Effect estimate: OR 2.73 (95% CI 1.33-5.62)

Absolute Event Rate: 15.9% vs 6.7%

p-value: p=0.006

Limitations

Residual confounding factors exist such as final diameter stenosis, lesion characteristics, and body mass index
Selection bias possible due to only including patients undergoing repeat coronary angiography
Single pre-procedural blood pressure may not reflect the patient's usual blood pressure

Abstract

Background: In the era of drug-eluting stents (DESs), few studies have explored the association between arterial stiffness and the risk of in-stent restenosis (ISR). Methods: Pulse pressure and pulse pressure index (PPI), which are noninvasive measures of arterial stiffness, were measured before percutaneous coronary interventions (PCI). PPI is the ratio of pulse pressure to systolic blood pressure. ISR was defined based on the angiographic evidence of ≥50% stenosis within the previously stented segment. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for ISR. Results: A total of 644 patients were collected, including 72 patients in the ISR group. Pulse pressure and PPI were significantly higher in the ISR group (ISR vs no ISR: pulse pressure, 58.5 ± 16.3 vs 53.1 ± 13.7 mmHg p = 0.002; PPI, 0.43 ± 0.07 vs 0.40 ± 0.07 p = 0.001). Multivariable-adjusted ORs for ISR, for tertile3 vs. tertile1, were 2.73 (95% CI, 1.33–5.62; p = 0.006) and 2.12 (95% CI, 1.04–4.31; p = 0.038) for pulse pressure and PPI, respectively. The ORs for ISR with a 1-standard deviation (SD) increase in pulse pressure and PPI were 1.41 (95% CI, 1.09–1.83; p = 0.010) and 1.52 (95% CI, 1.15–2.01; p = 0.003), respectively. Conclusions: Arterial stiffness denoted by high pulse pressure and PPI is a predictive factor for ISR. A pre-PCI wide pulse pressure could potentially serve as a marker of risk, as well as a potential target for future therapies. Clinical trial registration: ChiCTR2000039901, https://www.chictr.org.cn/showproj.html?proj=51063.

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