SynthesisBMC cardiovascular disorders2026
The persisting challenge of recurrent in-stent restenosis: a systematic review and meta-analysis of prevalence and prognostic risk factors.
Synthesis in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRecurrent 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.
methodsA 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.
resultsTwenty-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).
conclusionsTo 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.
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