, Mehmet Erdoğan 2
, Abdullah Nabi Aslan 3
, Nihal Akar 2
, Serkan Bulguroğlu 4
, Burak Kardeşler 5
, Mehmet Akif Erdöl 5
2Department of Cardiology, Ankara Yıldırım Beyazıt University Medical School, Ankara, Türkiye
3Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
4Department of Cardiology, University of Health Sciences, Hatay Dörtyol State Hospital, Hatay, Türkiye
5Department of Cardiology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Türkiye
Abstract
Background: This study investigated the relationship between whole blood viscosity (WBV) and in-stent restenosis (ISR) in patients with prior coronary stent implantation who underwent coronary angiography (CAG) for chronic coronary syndrome (CCS).
Methods: In this retrospective case-control study, 802 patients who underwent CAG with suspected ISR were included. In-stent restenosis was defined as ≥50% stenosis within the stent or within 5 mm of its edges. Patients were divided into an ISR group (n = 342) and a control group without ISR (n = 460). Whole blood viscosity was calculated using both high-shear rate viscosity (HSR) and low-shear rate viscosity (LSR).
Results: Whole blood viscosity levels were significantly higher in the ISR group for both HSR (16.8 ± 1.0 vs. 15.6 ± 0.9 cP, P < .001) and LSR (83.1 ± 8.4 vs. 80.8 ± 8.0 cP, P < .001). Receiver-operating characteristic curve (ROC) analysis showed strong predictive power for ISR (area under the curve [AUC] 0.84 for LSR and 0.82 for HSR). Kaplan–Meier analysis demonstrated significantly lower ISR-free survival in patients with high WBV (P < .001). Multivariate Cox regression identified both HSR and LSR as independent predictors of ISR.
Conclusion: Increased WBV is independently linked to ISR and may contribute to its development via endothelial inflammation and vascular remodeling. Whole blood viscosity demonstrates potential utility as a biomarker for the identification of CCS patients susceptible to ISR.