The baseline predictive value of the RNA-binding proteins IGF2BP3/IMP3 and UPF1 for in-stent restenosis after percutaneous coronary intervention in acute coronary syndrome: a retrospective cohort study

Objective To investigate the predictive capacity of baseline (pre-procedural) RNA-binding proteins insulin-like growth factor II mRNA-binding protein 3 (IGF2BP3/IMP3), upstream frameshift protein 1 (UPF1), and in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods A total of 1,380 ACS patients who underwent PCI at the Affiliated Hospital of Qingdao University from February 2020 to February 2024 were divided into ISR ( n = 216) and non-ISR ( n = 1,164) groups based on coronary angiography results 6 months post-procedure. Clinical, laboratory, and echocardiographic data were compared. Multivariate logistic regression identified ISR risk factors, and receiver operating characteristic (ROC) analysis evaluated the predictive value of IGF2BP3/IMP3 and UPF1. Results VEGF and IGF2BP3/IMP3 levels were significantly lower, while UPF1 was higher, in the ISR group ( P < 0.05). Compared with the non-ISR group, patients in the ISR group were significantly older, had higher proportions of current smokers and diabetes mellitus, elevated CRP levels, and worse echocardiographic parameters ( P < 0.05). Average stent length, stent numbers, and SYNTAX scores were also significantly different between the two groups ( P < 0.05). There were no significant differences in male gender, hypertension prevalence, or culprit vessel distribution. Multivariate logistic regression adjusted for clinical covariates (age, sex, current smoking, hypertension, and diabetes mellitus) identified that IGF2BP3/IMP3 (adjusted OR = 0.551, 95% CI: 0.354–0.860, P = 0.009) was independently associated with lower odds of ISR, whereas UPF1 (adjusted OR = 5.496, 95% CI: 1.906–15.852, P = 0.002) was independently associated with an increased likelihood of ISR ( P < 0.05). Furthermore, IGF2BP3/IMP3 was positively correlated with VEGF ( r = 0.192, P < 0.001), whereas UPF1 was negatively correlated with VEGF ( r = −0.239, P < 0.001). The UPF1/IGF2BP3/IMP3 ratio had the highest statistical predictive value for ISR (AUC = 0.870, 95% CI: 0.846−0.894, optimism-corrected AUC = 0.870, sensitivity 79.6%, specificity 79.0%). Conclusion Decreased IGF2BP3/IMP3 and VEGF and increased UPF1 are associated with ISR after PCI. The baseline UPF1/(IGF2BP3/IMP3) ratio provides strong longitudinal predictive value for post-PCI ISR in ACS patients.