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Background <p>In-stent neoatherosclerosis (ISNA) is a key mechanism underlying drug-eluting stent in-stent restenosis (DES-ISR), with inflammation playing a critical role. This study aimed to assess the association between the systemic immune-response index (SIRI) and ISNA in DES-ISR patients.</p> Methods <p>A retrospective analysis included 212 patients with DES-ISR who underwent coronary angiography and optical coherence tomography (OCT) at least 12&#xa0;months after stent implantation. SIRI was calculated as (neutrophil count × monocyte count)/lymphocyte count and divided into tertiles. Multivariate logistic regression, smooth curve fitting, threshold effect, and subgroup analyses were performed to evaluate the relationship between SIRI and ISNA risk.</p> Results <p>Higher SIRI tertiles were associated with ISNA and thin-cap fibroatheroma (all <i>P</i> &lt; 0.05). Multivariate analysis identified SIRI as an independent risk factor for ISNA (OR per unit increase 1.23, 95% CI 1.04–1.47, <i>P</i> = 0.018). Smooth curve fitting identified a non-linear association, highlighting a distinct threshold at a SIRI level of 3.95, below which the risk of ISNA rose sharply. Subgroup analysis revealed that the association between SIRI and ISNA risk was largely consistent across most subgroups, with a significant interaction observed only among patients younger than 60&#xa0;years (OR 1.94, 95% CI 1.23–3.05, <i>P</i> for interaction = 0.010).</p> Conclusion <p>SIRI is independently and non-linearly associated with the risk of ISNA in DES-ISR patients, with a distinct inflection point observed at a SIRI value of 3.95, below which elevated SIRI levels were significantly correlated with increased ISNA risk. Prospective studies are needed for further validation.</p>

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Threshold effect of systemic immune-response index on in-stent neoatherosclerosis among patients with drug-eluting stent restenosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月20日

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  • Shuangya Yang,
  • Qianhang Xia,
  • Ning Gu,
  • Changyin Shen,
  • Chancui Deng,
  • Xi Wang,
  • Yi Deng,
  • Xingwei Hu,
  • Jingjing Zhu,
  • Ranzun Zhao,
  • Bei Shi

摘要

Background

In-stent neoatherosclerosis (ISNA) is a key mechanism underlying drug-eluting stent in-stent restenosis (DES-ISR), with inflammation playing a critical role. This study aimed to assess the association between the systemic immune-response index (SIRI) and ISNA in DES-ISR patients.

Methods

A retrospective analysis included 212 patients with DES-ISR who underwent coronary angiography and optical coherence tomography (OCT) at least 12 months after stent implantation. SIRI was calculated as (neutrophil count × monocyte count)/lymphocyte count and divided into tertiles. Multivariate logistic regression, smooth curve fitting, threshold effect, and subgroup analyses were performed to evaluate the relationship between SIRI and ISNA risk.

Results

Higher SIRI tertiles were associated with ISNA and thin-cap fibroatheroma (all P < 0.05). Multivariate analysis identified SIRI as an independent risk factor for ISNA (OR per unit increase 1.23, 95% CI 1.04–1.47, P = 0.018). Smooth curve fitting identified a non-linear association, highlighting a distinct threshold at a SIRI level of 3.95, below which the risk of ISNA rose sharply. Subgroup analysis revealed that the association between SIRI and ISNA risk was largely consistent across most subgroups, with a significant interaction observed only among patients younger than 60 years (OR 1.94, 95% CI 1.23–3.05, P for interaction = 0.010).

Conclusion

SIRI is independently and non-linearly associated with the risk of ISNA in DES-ISR patients, with a distinct inflection point observed at a SIRI value of 3.95, below which elevated SIRI levels were significantly correlated with increased ISNA risk. Prospective studies are needed for further validation.