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Background <p>Recurrent in-stent restenosis (R-ISR) after percutaneous coronary intervention remains a clinically important failure mode, yet reported rates and predictors vary widely. We aimed to quantify the pooled incidence of R-ISR and synthesize multivariable risk factors.</p> Methods <p>A comprehensive literature search of the electronic database was updated on May 3, 2025. Studies reporting the incidence or analyzing the risk factors of R-ISR were eligible. Study quality was assessed using the Newcastle-Ottawa Scale. Data synthesis was achieved via random-effects meta-analysis using the R studio (version 4.4.3). Subgroup analyses considered region, treatment, and follow-up, with leave-one-out sensitivity analyses. The systematic review is reported in accordance with the PRISMA 2020 checklist.</p> Results <p>Twenty-three studies were included. The overall pooled incidence of R-ISR was 21.7% (95%CI 17.1%–27.2%), with variations by region (highest in Europe), treatment type (lowest with DES), and follow-up duration (highest within 6 months). Significant risk factors included renal disease (OR 3.90; 95%CI 1.87–8.11), non-focal restenosis (OR 3.29; 95%CI 2.41–4.49), lesion length (OR 1.15; 95%CI 1.06–1.24), heterogeneous tissue pattern (OR 3.36; 95%CI 1.69–6.67), stent fracture (OR 2.21; 95%CI 1.29–3.79), and higher percentage diameter stenosis (OR 1.05; 95%CI 1.03–1.06). Age showed non-significant association (OR 0.96; 95%CI 0.93–1.00).</p> Conclusions <p>To our knowledge, this is among the first systematic reviews and meta-analyses specifically focused on recurrent ISR after treatment of ISR lesions. Renal disease, non-focal morphology, lesion length, heterogeneous tissue pattern, stent fracture and greater post-procedural percentage diameter stenosis were consistently associated with higher risk of R-ISR. These findings support individualized treatment selection with intensified secondary prevention and closer surveillance during the first six months after the recent percutaneous coronary intervention performed for ISR.</p> Prospero registration number <p>CRD420251043520</p>

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The persisting challenge of recurrent in-stent restenosis: a systematic review and meta-analysis of prevalence and prognostic risk factors

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月29日

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  • Hongxiu Chen,
  • Zhenjun Yuan,
  • Shuai Zhang,
  • Xiuying Hu,
  • Ji Bao,
  • Guan Wang

摘要

Background

Recurrent in-stent restenosis (R-ISR) after percutaneous coronary intervention remains a clinically important failure mode, yet reported rates and predictors vary widely. We aimed to quantify the pooled incidence of R-ISR and synthesize multivariable risk factors.

Methods

A comprehensive literature search of the electronic database was updated on May 3, 2025. Studies reporting the incidence or analyzing the risk factors of R-ISR were eligible. Study quality was assessed using the Newcastle-Ottawa Scale. Data synthesis was achieved via random-effects meta-analysis using the R studio (version 4.4.3). Subgroup analyses considered region, treatment, and follow-up, with leave-one-out sensitivity analyses. The systematic review is reported in accordance with the PRISMA 2020 checklist.

Results

Twenty-three studies were included. The overall pooled incidence of R-ISR was 21.7% (95%CI 17.1%–27.2%), with variations by region (highest in Europe), treatment type (lowest with DES), and follow-up duration (highest within 6 months). Significant risk factors included renal disease (OR 3.90; 95%CI 1.87–8.11), non-focal restenosis (OR 3.29; 95%CI 2.41–4.49), lesion length (OR 1.15; 95%CI 1.06–1.24), heterogeneous tissue pattern (OR 3.36; 95%CI 1.69–6.67), stent fracture (OR 2.21; 95%CI 1.29–3.79), and higher percentage diameter stenosis (OR 1.05; 95%CI 1.03–1.06). Age showed non-significant association (OR 0.96; 95%CI 0.93–1.00).

Conclusions

To our knowledge, this is among the first systematic reviews and meta-analyses specifically focused on recurrent ISR after treatment of ISR lesions. Renal disease, non-focal morphology, lesion length, heterogeneous tissue pattern, stent fracture and greater post-procedural percentage diameter stenosis were consistently associated with higher risk of R-ISR. These findings support individualized treatment selection with intensified secondary prevention and closer surveillance during the first six months after the recent percutaneous coronary intervention performed for ISR.

Prospero registration number

CRD420251043520