We aimed to investigate prognostic factors of in-stent restenosis (ISR) within 3 years in older acute coronary syndrome (ACS) patients after drug-eluting stent (DES) implantation and establish a clinical model for predicting ISR. We retrospectively collected 215 older ACS patients who followed coronary angiography (CAG) after DES implantation, divided into ISR group and non in-stent restenosis (non-ISR) group according to the results of reviewed CAG. Logistic regression analysis was performed to screen independent predictors related to ISR and build the clinical predictive model, which clinical application was assessed by decision curve analysis (DCA) and clinical impact curve (CIC). Kaplan-Meier survival curves for ISR by independent predictors. In multivariate logistic regression analysis showed that the red cell distribution width (RDW) was higher in ISR group compared with non-ISR (odds ratio (OR) = 1.54, 95% confidence interval (CI): 1.14–2.08, p < 0.01). Instead, a negative correlation was observed between minimum stent diameter and ISR (OR = 0.28, 95%CI:0.09-0.86, p = 0.03). A novel nomogram composed of these significant features presented a concordance index (C-index) of 0.710, DCA and CIC suggested that the predictive nomogram had clinical utility. Schoenfeld residuals showed the model RDW ≥ 12.6% with minimum stent diameter <3 mm was consistent with the proportional risk assumption. The Kaplan-Meier estimate for ISR showed statistical significance. Higher levels of RDW and lower minimum stent diameter were associated with incidence of ISR within 3 years in older ACS patients after DES implantation.

我们旨在调查老年急性冠状动脉综合征（ACS）患者药物洗脱支架（DES）植入后3年内支架内再狭窄（ISR）的预后因素，并建立预测ISR的临床模型。我们回顾性收集了 215 例老年 ACS 患者在 DES 植入后进行冠状动脉造影（CAG），根据 CAG 回顾结果分为 ISR 组和非支架内再狭窄（non-ISR）组。采用Logistic回归分析筛选ISR相关的独立预测因子，建立临床预测模型，通过决策曲线分析（DCA）和临床影响曲线（CIC）评估临床应用。独立预测因子对 ISR 的 Kaplan-Meier 生存曲线。多元逻辑回归分析显示，ISR 组的红细胞分布宽度 (RDW) 高于非 ISR 组（优势比 (OR) = 1.54, 95% 置信区间 (CI): 1.14-2.08, p < 0.01） . 相反，在最小支架直径和 ISR 之间观察到负相关（OR = 0.28, 95%CI:0.09-0.86, p = 0.03）。由这些重要特征组成的新型列线图呈现出 0.710 的一致性指数（C 指数），DCA 和 CIC 表明预测列线图具有临床实用性。Schoenfeld 残差显示模型 RDW ≥ 12.6%，最小支架直径 <3 mm 与比例风险假设一致。ISR 的 Kaplan-Meier 估计显示出统计学意义。