Elevated METS-IR levels were strongly correlated with an increased risk of in-stent restenosis, with a markedly pronounced impact on severe ISR (>70%), establishing METS-IR as a straightforward and practical predictor for risk stratification after coronary stent implantation.
Patients with in-stent restenosis greater than 50% had significantly higher METS-IR scores than those without ISR.
Patients with severe in-stent restenosis greater than 70% also had significantly higher METS-IR scores compared to those without severe ISR.
ISR prevalence increased progressively across METS-IR tertiles.
Multivariate logistic regression confirmed METS-IR as an independent predictor of both ISR >50% and severe ISR >70%.
ROC analysis identified an optimal METS-IR cutoff value of 42.27 for predicting both ISR >50% and ISR >70%.
The study was a retrospective cohort of 818 patients undergoing repeat coronary angiography after PCI.
This research suggests that a relatively new measurement called the Metabolic Score for Insulin Resistance (METS-IR) — which combines routine blood and body measurements to estimate how well the body responds to insulin — can help predict whether a patient will develop re-narrowing inside a coronary stent (called in-stent restenosis or ISR) after a procedure to open blocked heart arteries. The study looked at 818 patients who had already received a coronary stent and then came back with recurring chest pain requiring a second look at their arteries. Patients whose arteries had re-narrowed by more than 50% or more than 70% had meaningfully higher METS-IR scores than those whose stents remained open, and higher METS-IR scores were associated with progressively greater risk of restenosis across all levels of the score. The association held up even after accounting for other known risk factors, with each unit increase in METS-IR linked to a 28% higher odds of moderate restenosis and a 51% higher odds of severe restenosis. A cutoff score of 42.27 was identified as a potential threshold to flag higher-risk patients, though sensitivity (50%) and specificity (63%) at that threshold were modest. The effect of METS-IR was especially pronounced for severe restenosis (>70% narrowing), suggesting that insulin resistance plays a particularly important role when restenosis is most clinically significant. This research suggests that routinely calculating METS-IR — which can be done from standard lab and physical measurements without additional testing — could help clinicians identify patients at higher risk for stent failure after percutaneous coronary intervention. This could potentially inform more personalized follow-up schedules or preventive strategies, though the retrospective design and modest discriminatory performance of the cutoff point to the need for further prospective validation before clinical implementation.
Tang J, Xu P, Guo J, Hao P. (2026). Usefulness of metabolic score for insulin resistance to predict restenosis after coronary stent implantation.. Annals of medicine. https://doi.org/10.1080/07853890.2026.2679841