[Effect of mycophenolate mofetil on in-stent restenosis after percutaneous coronary intervention in patients with autoimmune hepatitis and overlap syndrome complicated with coronary heart disease].
Dong F, Lu H, Chen X, Liu C • Zhonghua yi xue za zhi • 2026
Mycophenolate mofetil use is associated with a reduced risk of in-stent restenosis after PCI in patients with autoimmune hepatitis and overlap syndrome complicated with coronary heart disease.
Key Findings
Results
In this retrospective single-center cohort of 172 patients with autoimmune liver disease and coronary heart disease who underwent PCI, 48 (27.9%) received mycophenolate mofetil postoperatively and 124 (72.1%) did not.
Patients were treated at Tianjin Medical University Second Hospital between January 2019 and December 2025 and followed up until March 31, 2026.
Autoimmune liver disease included AIH, PBC, PSC, and overlap syndrome.
Median follow-up [M(Q1, Q3)] was 13 (7, 16) months in the mycophenolate mofetil group and 10 (5, 16) months in the non-mycophenolate mofetil group.
Results
At baseline, the mycophenolate mofetil group had lower proportions of hyperlipidemia and diabetes than the non-mycophenolate mofetil group.
Hyperlipidemia: 12.5% (6/48) vs 32.3% (40/124), P=0.009.
Diabetes mellitus: 8.3% (4/48) vs 27.4% (34/124), P=0.007.
Results
At baseline, the mycophenolate mofetil group had higher inflammation, liver injury and immunoglobulin markers and more prior immunosuppressant use.
hs-CRP >0.8 mg/L: 47.9% (23/48) vs 27.4% (34/124), P=0.010.
Previous prednisone use: 79.2% (38/48) vs 22.6% (28/124), P<0.001; previous azathioprine use: 54.2% (26/48) vs 9.7% (12/124), P<0.001.
AST: 59.5 (35.5, 76.8) vs 43.0 (32.0, 52.7) U/L, P=0.002; IgG: 19.6 (15.0, 26.0) vs 15.2 (14.0, 16.8) g/L, P=0.006.
Results
Among 100 patients with AIH and overlap syndrome, mycophenolate mofetil use was associated with a reduced risk of in-stent restenosis in both the Firth-corrected Cox model and the competing risk model.
The 100 patients comprised 82 with AIH and 18 with overlap syndrome; PBC and PSC were excluded from this analysis because few such patients received mycophenolate mofetil.
Fine-Gray competing risk model (all-cause death as competing event): sHR=0.14, 95%CI: 0.05-0.43, FDR q=0.003.
Results
After 1:1 propensity score matching (40 patients per group), baseline covariates were balanced and the 12-month ISR-free survival rate was higher in the mycophenolate mofetil group.
All covariates had SMD<0.1 after matching.
Median follow-up after PSM was 12 (7, 15) months in the mycophenolate mofetil group and 8 (3, 17) months in the non-mycophenolate mofetil group.
12-month ISR-free survival: 97.0% vs 64.5%, P<0.001 (Kaplan-Meier analysis).
Results
In a sensitivity analysis including all autoimmune liver disease patients, mycophenolate mofetil use remained associated with a reduced risk of in-stent restenosis.
The effect estimates were attenuated relative to the AIH and overlap syndrome-only analysis.
Methods
The study used penalized and competing-risk methods with multiple-comparison correction to address small event numbers and death as a competing event.
Firth penalized likelihood-corrected Cox regression was used.
Fine-Gray models treated all-cause death as the competing event.
Benjamini-Hochberg correction was applied to calculate FDR q values.
What This Means
This study looked back at medical records of 172 patients with autoimmune liver disease who also had heart disease and received a coronary stent at one hospital in Tianjin, China. It compared those who took mycophenolate mofetil, an immune-suppressing drug, after the procedure with those who did not. The main outcome was in-stent restenosis, where the treated artery narrows again.
Among 100 patients with autoimmune hepatitis or overlap syndrome, those taking mycophenolate mofetil had a much lower risk of in-stent restenosis. After matching patients on baseline characteristics, 97.0% of the mycophenolate group were free of restenosis at 12 months, compared with 64.5% of the non-mycophenolate group. A broader analysis including all autoimmune liver disease patients pointed in the same direction, with a somewhat smaller effect.
This research suggests a possible link between this drug and less artery re-narrowing in this specific patient group. However, the study was retrospective, done at one hospital, and fairly small. The two groups differed at the start: the drug group had less diabetes and high cholesterol but more inflammation and more prior immunosuppressant use. The findings show an association, not proof that the drug prevents restenosis, and would need confirmation in larger, prospective studies.
Dong F, Lu H, Chen X, Liu C. (2026). [Effect of mycophenolate mofetil on in-stent restenosis after percutaneous coronary intervention in patients with autoimmune hepatitis and overlap syndrome complicated with coronary heart disease].. Zhonghua yi xue za zhi. https://doi.org/10.3760/cma.j.cn112137-20260509-01235