Predictors of adverse cardiovascular events in patients with coronary artery disease after percutaneous coronary intervention

Aim. To identify predictors of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI).

Material and methods. This prospective single-center study included 225 patients with stable CAD requiring drug-eluting stent implantation. The average follow-up period for patients was 14,5 (6;23) months. Levels of glycated hemoglobin (HbA1c), insulin, tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), interleukin-10 (IL-10), endothelin-1 (ET-1) and the serum lipid profile were evaluated. Insulin resistance was assessed by the HOMA-IR index. The patients were divided into 2 groups: group 1 (n=98) — patients with MACE, group 2 (n=127) — patients without MACE over the follow-up period.

Results. During the follow-up period, MACE were recorded in 43,5% of patients, of which: fatal outcome in 3 (3,1%) patients, acute coronary syndrome (ACS) — 14 (14,3%), decompensated heart failure (HF) — 8 (8,2%), non-fatal myocardial infarc tion (MI) — 4 (4,1%), stroke — 3 (3,1%), in-stent restenosis — 18 (18,4%), target vessel revascularization due to progression of atherosclerosis — 25 (25,4%), lifethreatening arrhythmias — 18 (18,4%), implantation of a cardiac resynchronization therapy defibrillator — 5 (5%). To determine critical levels for quantitative predictors, ROC curves were created with threshold values that increase the likelihood of MACE.

Conclusion. As a result of the study, we found that the waist-to-hip ratio >1,0495, the HOMA-IR index >3,13 and the endothelin-1 >0,75 mmol/L are independent predictors of unfavorable prognosis in patients with CAD after PCI.

1. Barbarash OL, Voyevoda MI, Galstyan GR, et al. Pre-diabetes as an interdisciplinary problem: definition, risks, approaches to the diagnostics and prevention of type 2 diabetes and cardiovascular complications. Russian Journal of Cardiology. 2019;(4):83-91. (In Russ.) doi:10.15829/1560-4071-2019-4-83-91.

2. Batalina MV, Fedyunina VA, Batalin VA, et al. Nephrological aspects of acute coronary syndrome. Orenburg medical vestnik. 2019;7:14-19. (In Russ.)

3. Golukhova EZ, Grigoryan MV, Ryabinina MN, Bulaeva NI. Clinical and laboratory predictors of adverse cardiac events in patients with coronary heart disease after planned percutaneous coronary intervention. Rational Pharmacotherapy in Cardiology. 2016;5;528-35. (In Russ.) doi:10.20996/1819-6446-2016-12-5-528-535.

4. Tomilova DI, Karpov YA, Lopukhova VV. Clinical outcomes of percutaneous coronary intervention with drag eluting stent instable angina patients. Russian Journal of Cardiology. 2017;(8):7-12. (In Russ.) doi:10.15829/1560-4071-2017-8-7-12.

5. National clinical guidelines: Diagnosis and treatment of metabolic syndrome (second review). Cardiovascular therapy and prevention. 2009;1-392. Supl. 2. (In Russ.)

6. Loureiro LM, Cordeiro A, Mendes R, et al. Clinic, Anthropometric And Metabolic Changes In Adults With Class III Obesity Classified As Metabolically Healthy And Metabolically Unhealthy. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2019;12:2419-31. doi:10.2147/DMSO.S210616.

7. Kim D-W, Kim J-Y, Jeong H. Comparison of Body Mass Index, Waist Circumference, and Waist-to-Height Ratio as a Predictors of Abdominal Fat Distribution in Male Examinees from the Health Promotion Center. Korean J Fam Pract. 2017;7(4):596-9. doi:10.21215/kjfp.2017.7.4.596.

8. Mozumdar A, Liguori G. Persistent increase of prevalence of metabolic syndrome among U.S. adults: NHANES III to NHANES 1999-2006. Diabetes Care. 2011;34(1):216-19. doi:10.2337/dc10-0879.

9. Gruzdeva OV, Akbasheva OE, Borodkina DA, et al. Relationship of obesity parameters and adipokines with the risk of 2nd type diabetes development in a year after myocardial infarction. Russian Journal of Cardiology. 2015;(4):59-67. (In Russ.) doi:10.15829/15604071-2015-4-59-67.

10. Beverly JK, Budoff MJ. Atherosclerosis: Pathophysiology of insulin resistance, hyperglycemia, hyperlipidemia, and inflammation. Journal of Diabetes. 2020;12:102-4. doi:10.1111/1753-0407.12970104.

11. Dylan O, Grunewald I, Ghiarone T, et al. Persistent insulin signaling coupled with restricted PI3K activation causes insulin-induced vasoconstriction. American Journal of PhysiologyHeart and Circulatory. 2019;317:1166-72. doi:10.1152/ajpheart.00464.2019.

12. Sato A, Satoh Y, Endo S, et al. Endothelial ERK2/thromboxane receptor pathway induces endothelial dysfunction, insulin resistance and steatohepatosis through superoxide with high fat high sucrose diet. European Heart Journal. 2019;40(1):ehz747.0341. doi:10.1093/eurheartj/ehz747.0341.

13. Jankowich M, Choudharyac G. Endothelin-1 levels and cardiovascular events. Trends in Cardiovascular Medicine. 2020;30(1):1-8. doi:10.1016/j.tcm.2019.01.007.

14. Liberale L, Camici G. The Role of Vascular Aging in Atherosclerotic Plaque Development and Vulnerability. Current Pharmaceutical Design. 2019;25(29):3098-111. doi:10.2174/1381612825666190830175424.

15. Zhou BY, Guo YL, Wu NQ, et al. Plasma big endothelin-1 levels at admission and future cardiovascular outcomes: A cohort study in patients with stable coronary artery disease. International Journal of Cardiology. 2017;230:76-9. doi:10.1016/j.ijcard.2016.12.082.