Key result
Multi-vessel disease (HR 2.921), lower HDL cholesterol, and insulin use were independent predictors of the progression of new coronary lesions requiring additional PCI, which occurred in 17.6% of patients at 5 years.
Cohort (n=1,214)
No
In Japanese CAD patients after PCI, progression of new coronary lesions requiring intervention is common and independently predicted by multi-vessel disease, lower HDL cholesterol, and insulin use.
Revascularization of an initially non-target site due to its progression as a new culprit lesion has emerged as a new therapeutic target of coronary artery disease (CAD) in the era of drug-eluting stents. Using the Shinken database, a single-hospital-based cohort, we aimed to clarify the incidence and prognostic factors for progression of previously non-significant coronary portions after prior percutaneous coronary intervention (PCI) in Japanese CAD patients. We selected from the Shinken database a single-hospital-based cohort of Japanese patients (n = 15227) who visited the Cardiovascular Institute between 2004 and 2010 to undergo PCI. This study included 1,214 patients (median follow-up period, 1,032 ± 704 days). Additional clinically driven PCI to treat previously non-significant lesions was performed in 152 patients. The cumulative rate of new-lesion PCI was 9.5 % at 1 year, 14.4 % at 3 years, and 17.6 % at 5 years. There was no difference in background clinical characteristics between patients with and without additional PCI. Prevalence of multi-vessel disease (MVD) (82 vs. 57 %, p < 0.001) and obesity (47 vs. 38 %, p = 0.028) were significantly higher and high-density lipoprotein cholesterol (HDL) level (51 ± 15 vs. 47 ± 12 mg/dl, p < 0.001) was significantly lower in patients with additional PCI than those without. Patients using insulin (6 vs. 3 %, p = 0.035) were more common in patients with additional PCI. Multivariate analysis showed that MVD, lower HDL, and insulin use were independent determinants of progression of new culprit coronary lesions. In conclusion, progression of new coronary lesions was common and new-lesion PCI continued to occur beyond 1 year after PCI without attenuation of their annual incidences up to 5 years. Greater coronary artery disease burden, low HDL, and insulin-dependent DM were independent predictors of progression of new culprit coronary lesions.
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Kaneko et al. (2013) conducted a cohort in Coronary artery disease after percutaneous coronary intervention (n=1,214). Multi-vessel disease (MVD) vs. Absence of multi-vessel disease was evaluated on Progression of new coronary lesions requiring additional PCI (HR 2.921, 95% CI 1.922-4.439, p=<0.001). Multi-vessel disease (HR 2.921), lower HDL cholesterol, and insulin use were independent predictors of the progression of new coronary lesions requiring additional PCI, which occurred in 17.6% of patients at 5 years.
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