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Published on: January 28, 2020
Impact of risk factors on intervened and non-intervened coronary lesions
Xincheng Sheng1, Gan Yang1, Qing Zhang1
1Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University 160 Pu Jian Road, Shanghai 200127, China.
Insights
Blood glucose and chronic kidney disease impact both in-stent restenosis (ISR) and aggravated non-intervened coronary lesions (ANL). Elevated lipids, particularly non-HDL-C and ApoB, are risk factors specifically for ANL in patients with coronary artery disease.
Area of Science:
- Cardiology
- Vascular Biology
- Clinical Research
Background:
- In-stent restenosis (ISR) and aggravated non-intervened coronary lesions (ANL) are key concerns in coronary artery disease (CAD) progression.
- Common risk factors include hyperlipidemia, hypertension, diabetes, chronic kidney disease, and smoking.
- Comparative risk factor analysis for ISR and ANL progression is limited.
Purpose of the Study:
- To analyze and compare the distinct impacts of identical risk factors on ISR and ANL.
- To identify specific risk factors contributing to disease progression in patients with CAD post-percutaneous coronary intervention (PCI).
Main Methods:
- Study included 510 patients with multiple coronary lesions undergoing repeated coronary angiography (CAG).
- Patients had prior PCI with existing non-intervened coronary lesions.
Main Results:
- Hemoglobin A1c (HbA1c) and urinary albumin (UA) were independent risk factors for ISR.
- HbA1c, serum creatinine (Scr), and apolipoprotein B (ApoB) were independent risk factors for ANL.
- Non-high-density lipoprotein cholesterol (Non-HDL-C) and ApoB levels were significantly higher in the ANL-only group compared to the ISR-only group.
Conclusions:
- Blood glucose (HbA1c) and chronic kidney disease (Scr) are independent risk factors for both ISR and ANL.
- Elevated lipid levels, specifically Non-HDL-C and ApoB, are significantly associated with ANL progression.
- Monitoring Non-HDL-C and ApoB is crucial for assessing risk in patients with non-intervened lesions post-PCI.
Introduction:
In-stent restenosis (ISR) and aggravated non-intervened coronary lesions (ANL) are two pivotal aspects of disease progression in patients with coronary artery disease (CAD). Established risk factors for both include hyperlipidemia, hypertension, diabetes, chronic kidney disease, and smoking. However, there is limited research on the comparative risk factors for the progression of these two aspects of progression. The aim of this study was to analyze and compare the different impacts of identical risk factors on ISR and ANL.
Methods:
This study enrolled a total of 510 patients with multiple coronary artery lesions who underwent repeated coronary angiography (CAG). All patients had previously undergone percutaneous coronary intervention (PCI) and presented non-intervened coronary lesions in addition to the previously intervened vessels.
Results:
After data analysis, it was determined that HbA1c (OR 1.229, 95% CI 1.022-1.477, P=0.028) and UA (OR 1.003, 95% CI 1.000-1.005, P=0.024) were identified as independent risk factors for ISR. Furthermore, HbA1c (OR 1.215, 95% CI 1.010-1.460, P=0.039), Scr (OR 1.007, 95% CI 1.003-1.017, P=0.009), and ApoB (OR 1.017, 95% CI 1.006-1.029, P=0.004) were identified as independent risk factors for ANL. The distribution of multiple blood lipid levels differed between the ANL only group and the ISR only group. Non-HDL-C (2.17 mmol/L vs. 2.44 mmol/L, P=0.007) and ApoB (63.5 mg/dL vs. 71.0 mg/dL, P=0.011) exhibited significantly higher values in the ANL only group compared to the ISR only group.
Conclusions:
Blood glucose levels and chronic kidney disease were identified as independent risk factors for both ISR and ANL, while elevated lipid levels were only significantly associated with ANL. In patients with non-intervened coronary lesions following PCI, it is crucial to assess the concentration of non-HDL-C and ApoB as they serve as significant risk factors.
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