Impact of risk factors on intervened and non-intervened coronary lesions.

Am J Cardiovasc Dis 2024;14(4):255-266 www.AJCD.us /ISSN:2160-200X/AJCD0158068 Original Article Impact of risk factors on intervened and non-intervened coronary lesions Xincheng Sheng, Gan Yang, Qing Zhang, Yong Zhou, Jun Pu Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160 Pu Jian Road, Shanghai 200127, China Received May 26, 2024; Accepted August 21, 2024; Epub August 25, 2024; Published August 30, 2024 Abstract: 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. Keywords: Progression of CAD, non-HDL-C, ApoB, blood glucose levels, chronic kidney disease Introduction Coronary artery disease (CAD) is a prominent cause of global mortality [1, 2]. With the advancement of coronary angiography (CAG) and percutaneous coronary intervention (PCI), intervention for complex coronary artery lesions has become more refined. In patients with multivessel coronary disease [2, 3], stenosis was treated based on the severity of the coronary artery lesions. Intervention therapy is recommended for unstable plaque or lesions with a diameter stenosis exceeding 70% (50% in the Left Main). Otherwise, the lesions can be temporarily treated with medication. Additional assessment tools such as intravascular ultrasound (IVUS) and fractional flow reserve (FFR) can provide supplementary information beyond CAG, assisting the interventional cardiologists in determining optimal treatment strategies. These patients with multivessel coronary disease are also faced with two aspects of disease progression: in-stent restenosis (ISR) [4, 5] and aggravated non-intervened coronary lesions (ANL) [6, 7]. As the follow-up period extends, there is a progressive increase in the incidences of both aspects of disease progression. The cumulative incidence of ISR requiring revascularization within the first year was 7.3%, and this trend persisted without attenuation for up to 5 years (2.2%/year) [8]. The cumulative incidence of ANL progression requiring additional PCI therapy increased from 6-10% in the initial post-PCI year to 14-16% in the 2nd and 3rd years, and https://doi.org/10.62347/XTBG3549 Risk factors on intervened and non-intervened lesions Figure 1. Study flowchart diagram. approximately 18% in the 5th year [9-11]. Various mechanisms contribute to the development of ISR, with neointimal hyperplasia being the predominant long-term mechanism. Risk factors associated with CAD can lead to both intimal hyperplasia and neointimal hyperplasia. Previous studies have demonstrated that hyperlipidemia, hypertension, diabetes, chronic kidney disease, and smoking are risk factors for CAD and can contribute to the development of both ISR and ANL [12, 13]. However, limited research has been conducted on the disparities in risk factors between these two types of disease progression. with a history of CABG, renal replacement therapy, autoimmune diseases, or malignant tumors undergoing chemotherapy or targeted drug treatment. Methods From January 2020 to December 2022, a total of 3,658 patients underwent CAG. Among them, 1,310 patients had a history of previous PCI. A subset of 325 patients lacking prior angiographic images were excluded from the analysis. Additionally, 43 patients with a history of CABG, renal replacement therapy, autoimmune diseases, or undergoing chemotherapy or targeted drug treatment for malignant tumors were also excluded. Finally, the previous angiographic images of 942 patients were analyzed. Among this group, 510 patients exhibited non-intervened coronary lesions in their prior angiography images and received long-term regular oral statin medication (Figure 1). Study population Coronary angiography This study is a retrospective trial. The enrolled patients met the following criteria: (1) prior history of drug-eluting stent (DES) implantation with non-intervened coronary lesions in vessels other than the target vessel; (2) underwent repeated CAG due to recurrent angina symptoms, positive treadmill exercise test, or coronary CTA revealing moderate to severe stenosis; (3) received long-term regular oral statin medication with lipid levels monitored postPCI. Exclusion criteria encompassed patients Non-intervened coronary lesion is defined as a coronary artery with a diameter stenosis ranging from 40% to 60% as observed in the previous angiography, which can be temporarily managed through medication rather than intervention. ANL is assessed using a similar angiographic approach and is defined as a diameter stenosis of ≥70% requiring additional intervention during the current angiography [9-11]. ISR is defined as a narrowing within the stent with a diameter exceeds 50% of the vessel lumen The aim of this study was to investigate patients with multivessel disease who underwent PCI and compare the impact of various risk factors, including lipid profiles, on both ISR and ANL. 256 Am J Cardiovasc Dis 2024;14(4):255-266 Risk factors on intervened and non-intervened lesions Figure 2. ISR and ANL. A: ISR; A1: previous angiography of ISR; A2: current angiography of ISR; B: ANL; B1: previous angiograp (...truncated)