Abstract Background Rapidly progressive coronary artery disease (RP-CAD) requires repeated hospitalization and/or percutaneous coronary intervention (PCI) within a short period of time despite standard treatment (intensified secondary prevention and PCI with new-generation drug-eluting stents or drug-coated balloons). Inflammation might involve in the pathogenesis of RP-CAD, as both atherosclerosis and post-PCI intimal hyperplasia are associated with inflammation. Purpose This cohort study preliminarily evaluated the impact of comprehensive treatment on the outcomes in RP-CAD patients. Methods Patients were eligible for study participation once they were diagnosed as RP-CAD and received comprehensive treatment. The diagnostic criteria for RP-CAD were: 1) hospitalization for typical symptoms and non-invasive evidence of myocardial ischemia despite standard treatment; 2) angiographic evidence of new or worsened coronary de novo or restenotic lesions relevant to myocardial ischemia, which occurred within 6 months, or 12 months for patients receiving immunosuppressive therapy (IST), of the latest PCI. Patients with restenosis due to mechanical etiologies and those with active infections or malignancies were excluded. Comprehensive treatment consisted of IST (glucocorticoids and immunosuppressive agents) in addition to standard treatment. The primary endpoint was the time between the start of treatment and the next major adverse cardiovascular event (MACE), i.e., the composites of death, or Q wave myocardial infarction, or unplanned ischemia-driven revascularization, or unplanned ischemia-driven hospitalization. The safety endpoints included severe infection events and major bleeding events. Results From April 2022 to December 2024, 40 patients were enrolled with an age of 55 (48, 60.5), 32 (80%) of whom were females. Thirty-seven (92.5%) patients demonstrated manifestations of inflammation, i.e., positive inflammation markers or autoantibodies, or diagnosis of chronic inflammatory diseases, or use of IST. The time between the first PCI and study enrollment was 26.5 (16, 42) months, during which PCI was performed for 4 (3, 5) times. Before the initiation of comprehensive treatment, the median time between the start of the latest standard treatment (the time of the latest PCI before study enrollment) and the next MACE (the index hospitalization) was 5 (3, 7) months. After the initiation of comprehensive treatment, 1) the median time between the start of comprehensive treatment (the time of the index PCI) and the next MACE could not be calculated, because MACEs occurred in only 8 (20%) patients during the follow-up of 10.5 (7, 18) months (until December 2024); 2) severe infection events and major bleeding events occurred in 7 (17.5%) and 2 (5%) patients, respectively. Conclusions Comprehensive treatment might delay the occurrence of MACEs but might increase severe infection events and major bleeding events in RP-CAD patients.Figure 1
Liu et al. (Sat,) studied this question.