PeerJ. 2026 Oct 13;14:e21697. doi: 10.7717/peerj.21697. eCollection 2026.
ABSTRACT
BACKGROUND: Coronary artery disease (CAD) combined with diabetes mellitus (DM) significantly increases the risk of vascular restenosis following percutaneous coronary intervention (PCI). Despite advancements in stent technology, restenosis remains a concern, especially in diabetic patients. This study aims to predict restenosis risk using serum metabolites and risk factors.
METHODS: A retrospective analysis was conducted on 272 CAD and type 2 diabetes mellitus (T2DM) patients who underwent PCI between January 2020 and June 2023. Based on one-year angiographic follow-up, patients were divided into restenosis (n = 121) and non-restenosis groups (n = 151). Serum metabolites and biomarkers, including glycated hemoglobin (HbA1c), insulin-like growth factor I (IGF-I), low-density lipoprotein cholesterol (LDL-C), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hsCRP), were evaluated, together with procedure-related characteristics (including stent type and post-procedural percentage diameter stenosis) and medication use (including calcium antagonists). Logistic regression and correlation analysis identified significant predictors, and a nomogram prediction model was developed and internally validated using bootstrap resampling.
RESULTS: Lower HbA1c levels were associated with restenosis (rho = -0.142, P = 0.008; OR = 0.767, 95% CI [0.625-0.941]). Higher levels of IGF-I (rho = 0.328, P < 0.001; OR = 1.053, 95% CI [1.032-1.075]), LDL-C (r = 0.135, P = 0.025; OR = 1.682, 95% CI [1.107-2.555]), TNF-α (r = 0.172, P = 0.004; OR = 1.434, 95% CI [1.119-1.838]), and hsCRP (r = 0.179, P = 0.003; OR = 1.786, 95% CI [1.185-2.693]) were also significantly associated. Non-drug-eluting stents (DES) and higher percentage diameter stenosis (%DS) increased restenosis risk. Calcium antagonists use was negatively correlated with restenosis (r = - 0.185, P = 0.002; OR = 0.449, 95% CI [0.228-0.884]). The nomogram model demonstrated good discrimination for restenosis (apparent AUC = 0.833; bootstrap-corrected AUC = 0.808).
CONCLUSION: This study identified key predictive factors for post-PCI restenosis in CAD patients with DM through case-control analysis. The nomogram model showed good discrimination on internal bootstrap validation. Pending external validation, it may provide a useful exploratory tool to support risk stratification and inform management aimed at reducing the restenosis burden in high-risk cardiovascular populations.
PMID:42891319 | PMC:PMC13674360 | DOI:10.7717/peerj.21697