Key result
Diabetes, elevated PRU, PAI-1, and vWF activity independently predict MACE after elective PCI.
Why the study?
Complications and adverse events following PCI remain major factors influencing morbidity and mortality, creating a need to predict secondary vascular occlusions.
What are the independent clinical and laboratory predictors of major adverse cardiac events in patients with stable ischemic heart disease following elective percutaneous coronary intervention?
Case-Control (n=94)
No
What are the independent clinical and laboratory predictors of major adverse cardiac events in patients with stable ischemic heart disease following elective percutaneous coronary intervention?
Diabetes, high on-treatment platelet reactivity, elevated PAI-1, and increased vWF activity independently predict MACE following elective PCI with drug-eluting stents.
May identify higher-risk patients after elective PCI; hypothesis-generating and requires prospective validation before clinical use.
Background. Despite recent advances in stent design and constantly improving protective pharmacological strategies, complications and adverse events following percutaneous coronary interventions (PCI) are still major factors influencing morbidity and mortality. Therefore, predicting secondary vascular occlusions represents an unmet medical need. Aim. To triage clinical and laboratory predictors of major adverse clinical events (MACE) following coronary stenting. Material and methods. This was a prospective, case-controlled, single-center study, which included 94 consecutive patients with documented ischemic heart disease (IHD) who underwent PCI with drug-eluting stent implantation. All patients received dual antiplatelet therapy with acetyl salicylic acid and clopidogrel. Numerous clinical characteristics and laboratory biomarkers were assessed before stenting, as well as CYP2C19 genotyping after patient’s discharge and were correlated with poststenting MACE over the mean follow-up of 28 months. MACE included death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and in-stent restenosis. Results. Twenty-three patients experienced MACE. According to univariate regression analysis we found following MACE predictors after PCI: diabetes mellitus (p=0.049), P2Y12 Reaction Units (PRU) according to VerifyNow® (p=0.01), number of stented arteries more than 2 (p=0.01), number of implanted stents more than 2 (p=0.01), baseline levels of plasminogen activator inhibitor-1 (PAI-1) (p=0.03) and von Willebrand activity (vWF) (p=0.01). Using multivariate analysis we demonstrated that concomitant diabetes mellitus, PRU ≥202, PAI-1 level ≥75.95 ng/ml, von Willebrand factor activity ≥155.15% are independent predictors of adverse cardiac events after PCI in stable IHD patients. Other clinical characteristics and laboratory indices, including CYP2C19*2 carriage, showed no significant impact on outcomes after elective PCI. Conclusions. Background diabetes mellitus, high on-treatment platelet reactivity (according to VerifyNow®), PAI-1 and vWF presenting activity may be useful for MACE prediction over 28 months of follow-up after PCI with drug-eluting stent implantation.
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Голухова et al. (2016) conducted a case-control in Ischemic heart disease following elective percutaneous coronary intervention (n=94). Clinical and laboratory predictors (diabetes mellitus, PRU ≥202, PAI-1 ≥75.95 ng/ml, vWF ≥155.15%) vs. Absence of these predictors was evaluated on Major adverse clinical events (MACE) including death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and in-stent restenosis. Concomitant diabetes mellitus, PRU ≥202, PAI-1 ≥75.95 ng/ml, and vWF activity ≥155.15% were independent predictors of MACE after elective PCI (overall MACE occurred in 23 of 94 patients).
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