CLINICAL OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION WITH DRUG ELUTING STENT IN STABLE ANGINA PATIENTS

Aim. To evaluate the occurence of cardiovascular events (CVE) and influence of lipid parameters on it, as other clinical and instrumental factors of coronary heart disease (CHD) patients during 5 years after selective percutaneous coronary intervention (PCI) with drug eluting stenting (DES).

Material and methods. In the study, 574 patients included, with stable angina (81% males, mean age 60,3 y. o.), hospitalized to the FSBI RCSPC of MHRF for selective PCI with implantation of DES. Patients were prescribed the therapy according to stable angina guidelines, including statins. The analysis was done, of various clinical and instrumental and laboratory parameters for evaluation of prognostic significance. The endpoints were assessed: lethal cases from cardiovascular, as from all causes, non-fatal myocardial infarction (MI), non-fatal stroke, repeated coronary revascularization, that happened after discharge.

Results. During the entire follow-up (average 53,5 months), CVE were registered in 24% cases. Totally, died 29 patients (5,1%), of those 4 (0,7%) — from non-cardiac causes, and repeat revascularization was done in 84 (14,6%) patients, non-fatal MI and stroke developed in 17 (3,0%) and 8 (1,3%), respectively. The risk factors were defined, that are related with the rate of fatal outcomes: smoking, brachiocephalic atherosclerosis, stroke in anamnesis, significant lesion of circumflex artery (CA) and its branches. Non-fatal stroke developed more oftenly in patients with higher body mass index (BMI) (32,2±2,56 versus 28,15±4,22, p=0,0164). Non-fatal MI more oftenly registered in patients with higher number and length of implanted stents (p=0,0018 and p<0,0001, resp.). By the end of follow-up, there were 66,2% patients on statins treatment. Target low density lipoproteides cholesterol (LDL-C) level (<1,8 mM/L) was found in 8,7%, median LDL-C level was 2,8 mM/L. There were no significant differences in LDL-C between those taking statins and discontinued,during 5 years. There was no significant relation of lipid profile values with CVE as well. The number of fatal cases was higher in the group of patients with lower baseline high density lipoproteide cholesterol.

Conclusion. Adverse events were found in about quarter of patients. Most of patients did not reach the target LDL-C. There was no significant relation in baseline LDL-C and its level in 5 years, with the occurence of MI, stroke, repeat revascularizations, all cause deaths. This can be explained by the absence of significant differences in LDL-C levels in patients continuing and discontinued statins during the follow-up, and is related to the use of insufficient statins dosages and low adherence to statin treatment.

1. Bibek S, Xie Y, Gao J et al. Role of Pre-procedural C-reactive Protein Level in the Prediction of Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention: a Meta-analysis of Longitudinal Studies. Inflammation 2015; 38(1):159—169.

2. Chazov EI, Karpov YuA. Rationale Pharmacotherapy For Cardiovascular Diseases. A guidebook for medical practitioners. Moscow Litterra Publishers 2014; 1056 p. Russian (Чазов Е.И., Карпов Ю.А. Рациональная фармакотерапия сердечно-сосудистых заболеваний. Руководство для практикующих врачей. Москва: Литтерра 2014; 1056 с).

3. Cholesterol Treatment Trialists’ (CTT) Collaborators, Mihaylova B, Emberson J et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380:581-590.

4. ESC/EAS Guidelines for the management of dyslipidaemias. European Heart Journal 2011; 32: 1769–1818.

5. Кухарчук ВВ, Коновалов ГА, Сусеков АВ и соавт. Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза. Российские рекомендации V пересмотр. Атеросклероз 2012; 2(8): 61-94.

6. Stone NJ, Robinson J, Lichtenstein AH et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 00: 000–000.

7. Di Sciascio G, Patti G, Pasceri V et al. Atorvastatin for Reduction of Myocardial Damage During Angioplasty (Efficacy of atorvastatin reload in patients on chronic statin therapy undergoing percutaneous coronary intervention: results of the ARMYDA RECAPTURE (Atorvastatin for Reduction of Myocardial Damage During Angioplasty) Randomized Trial. J Am Coll Cardiol 2009; 54: 558—565.

8. Ndrepepa G, Braun S, Tada T et al. Comparative prognostic value of low-density lipoprotein cholesterol and C-reactive protein in patients with stable coronary artery disease treated with percutaneous coronary intervention and chronic statin therapy. Cardiovasc Revasc Med. 2014; 15(3):131-136.

9. Puri R, Nissen SE, Libby P et al. C-reactive protein, but not low-density lipoprotein cholesterol levels, associate with coronary atheroma regression and cardiovascular events after maximally intensive statin therapy. Circulation 2013; 128(22):2395-2403.

10. Boytsov SA, Khomitskaya YuV. Centralised Survey on the Undertreatment of the Hypercholesterolemia in Russia (CEPHEUS). Cardiovascular Therapy and Prevention 2013; 12 (4): 67–74 (Бойцов СА, Хомицкая ЮВ. Централизованное исследование по оценке эффективности лечения гиперхолестеринемии в России (CEPHEUS). Кардиоваскулярная терапия и профилактика, 2013; 12 (4): 67–74).

11. Yao HM, Wan YD, Zhang XJ et al. Long-term follow-up results in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents: results from a single high-volume PCI centre. BMJ Open 2014; 4: e004892.

12. Zahn R, Neumann FJ, Buttner HJ et al. Long-term follow-up after coronary stenting with the sirolimus-eluting stent in clinical practice: results from the prospective multi-center German Cypher Stent Registry. Clin Res Cardiol 2012; 101:709-716.

13. Akhmedzhanov NM, Nebieridze DV, Safaryan AS et al. Analysis of hypercholesterolemia prevalence in the outpatient practice (according to the ARGO study): Part I. Rational Pharmacotherapy in Cardiology 2015;11(3): 253-260 (Ахмеджанов НМ, Небиеридзе ДВ, Сафарян АС и соавт. Анализ распространенности гиперхолестеринемии в условиях амбулаторной практики (по данным исследования АРГО): часть I. Рациональная Фармакотерапия в Кардиологии 2015;11(3): 253-260).

14. Goodman SG, Langer A, Bastien NR et al. Prevalence of dyslipidemia in statin-treated patients in Canada: results of the DYSlipidemia International Study (DYSIS). Can J Cardiol 2010; 26(9): 330-335.

15. Gitt AK, Junger C, Smolka W et al. Prevalence and overlap of different lipid abnormalities in statin-treated patients at high cardiovascular risk in clinical practice in Germany. Clin Res Cardiol 2010; 99(11): 723–733.