Zhonghua Yi Xue Za Zhi. 2026 Oct 27;106(39):4281-4288. doi: 10.3760/cma.j.cn112137-20260509-01235.
ABSTRACT
Objective: To investigate the effect of mycophenolate mofetil on in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in patients with autoimmune hepatitis (AIH) and overlap syndrome complicated with coronary heart disease. Methods: Patients with autoimmune liver diseases (AILD) [including AIH, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and overlap syndrome] complicated with coronary heart disease who underwent PCI at Tianjin Medical University Second Hospital between January 2019 and December 2025 were retrospectively enrolled, they were divided into mycophenolate mofetil group and non-mycophenolate mofetil group according to postoperative use of mycophenolate mofetil, and followed up until March 31, 2026 to compare the baseline characteristics of the two groups of patients. Firth penalized likelihood-corrected Cox regression models and Fine-Gray competing risk models (with all-cause death as the competing event) were used to evaluate the association between mycophenolate mofetil use and ISR after PCI in patients with AIH and overlap syndrome complicated with coronary heart disease (because few patients with PBC and PSC received mycophenolate mofetil, this analysis only included patients with AIH and overlap syndrome). The Benjamini-Hochberg method was applied for multiple comparison correction to calculate the FDR q values. A 1∶1 propensity score matching (PSM) was employed to balance baseline characteristics between the two groups. Kaplan-Meier method was used to plot survival curves to compare the ISR-free survival rates. Sensitivity analysis was performed on all AILD patients to validate the robustness of the results. Results: A total of 172 patients with AILD complicated with coronary heart disease were enrolled, including 48 cases (27.9%) in the mycophenolate mofetil group and 124 cases (72.1%) in the non-mycophenolate mofetil group. The follow-up duration [M(Q, Q)] was 13 (7, 16) and 10 (5, 16) months respectively. The proportion of patients with hyperlipidemia [12.5% (6/48) vs 32.3% (40/124), P=0.009] and diabetes mellitus [8.3% (4/48) vs 27.4% (34/124), P=0.007] were lower in the mycophenolate mofetil group than that in the non-mycophenolate mofetil group, while the proportion of patients with high-sensitivity C-reactive protein (hs-CRP)>0.8 mg/L [47.9% (23/48) vs 27.4% (34/124), P=0.010], previous use of prednisone [79.2% (38/48) vs 22.6% (28/124), P<0.001] and azathioprine [54.2% (26/48) vs 9.7% (12/124), P<0.001] were higher than that in the non-mycophenolate mofetil group. The levels of aspartate aminotransferase (AST) [59.5 (35.5, 76.8) vs 43.0 (32.0, 52.7) U/L, P=0.002] and immunoglobulin G (IgG) [19.6 (15.0, 26.0) vs 15.2 (14.0, 16.8) g/L, P=0.006] were higher in the mycophenolate mofetil group. Among 100 patients with AIH and overlap syndrome (82 and 18 cases, respectively), mycophenolate mofetil use was associated with a reduced risk of ISR in both Firth-corrected Cox regression model and competing risk model (Firth-corrected Cox model: HR=0.17, 95%CI: 0.04-0.51, FDR q=0.004; competing risk model: sHR=0.14, 95%CI: 0.05-0.43, FDR q=0.003). After PSM (40 cases in each group), there was no statistically significant difference in all covariates between the two groups (all SMD<0.1). After PSM, Kaplan-Meier survival analysis demonstrated that the follow-up duration was 12 (7, 15) months in the mycophenolate mofetil group and 8 (3, 17) months in the non-mycophenolate mofetil group. The 12-month ISR-free survival rate was higher in the mycophenolate mofetil group than that in the non-mycophenolate mofetil group (97.0% vs 64.5%, P<0.001). In the sensitivity analysis, mycophenolate mofetil use is associated with a reduced risk of ISR (Firth-corrected Cox regression model: HR=0.29, 95%CI: 0.09-0.73, FDR q=0.030; competing risk model: sHR=0.26, 95%CI: 0.10-0.72, FDR q=0.022). Conclusion: Mycophenolate mofetil use is associated with a reduced risk of ISR after PCI in patients with AIH and overlap syndrome complicated with coronary heart disease.
PMID:42927961 | DOI:10.3760/cma.j.cn112137-20260509-01235