A systematic review and bioinformatic study on clinical, paraclinical, and genetic factors predisposing to stent restenosis following percutaneous coronary intervention

BACKGROUND

Stent restenosis is a relatively common phenomenon among patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). It seems that a set of clinical, laboratory, and even genetic factors make people susceptible to such a phenomenon and in fact, this is multi-factorial. We aimed to first determine the underlying clinical and laboratory risk factors for the occurrence of stent re-stenosis after PCI based on a systematic review study, and after that, through a bioinformatics study, to evaluate the related genes and microRNAs with the occurrence of stent re-stenosis.

MAIN TEXT

In the first step, the manuscript databases including Medline, Web of Knowledge, Google Scholar, Scopus, and Cochrane were deeply searched by the two blinded investigators for all eligible studies based on the considered keywords to introduce clinical and laboratory determinants of stent re-stenosis. In the bioinformatic phase, and following a review of the literature to identify genes and microRNAs involved in restenosis, the interaction of each gene with other genes associated with stent re-stenosis was determined by GeneMANIA network analysis and Cytoscape software. Overall, 67 articles (including 40,789 patients) on clinical and biochemical predictors for stent restenosis and 25 articles on genetic determinants of this event were eligible for the final analysis. The predictors for this event were categorized into four subgroups patient-based parameters including traditional cardiovascular risk profiles, stent-based parameters including type and diametric characteristics of the stents used, coronary lesion-based parameters including several two target lesions and coronary involvement severity and laboratory-based parameters particularly related to activation of inflammatory processes. In the bioinformatic phase, we uncovered 42 genes that have been described to be involved in such a phenomenon considering a special position for genes encoding inflammatory cytokines. Also, 12 microRNAs have been pointed to be involved in targeting genes involved in stent re-stenosis.

CONCLUSIONS

The incidence of stent re-stenosis will be the result of a complex interaction of clinical risk factors, laboratory factors mostly related to the activation of inflammatory processes, and a complex network of gene-to-gene interactions.

Association between LDL/HDL ratio and in-stent restenosis in patients with acute coronary syndrome after stent implantation

Background: The relationship between LDL/HDL ratio and in-stent restenosis in acute coronary syndrome is unknown. Methods: This observational study recruited 256 patients with acute coronary syndrome who were being followed up by angiography after stenting. The patients were divided into in-stent restenosis (59%) and non-in-stent restenosis (41%) groups. Three stepwise multivariate logistic regression models and area under the curve were conducted to determine the role of LDL/HDL ratio in predicting in-stent restenosis. Results: LDL/HDL ratio was significantly associated with risk of in-stent restenosis (odds ratio ≈ 2.00; p < 0.05 for all) in three models. A good predictive performance of LDL/HDL ratio on in-stent restenosis was found with an area under the curve of 0.74. Conclusion: LDL/HDL ratio was independently associated with the risk of in-stent restenosis in acute coronary syndrome.

Incidence and risk factors of in-stent restenosis after percutaneous coronary intervention in patients from southern China

Background

In-stent restenosis (ISR) remains a challenge for coronary artery disease (CAD) patients who undergo percutaneous coronary intervention (PCI) with stents, and risk factors for ISR are controversial. This study aimed to investigate the incidence and risk factors of ISR in patients from southern China.

Methods

In this retrospective study, patients diagnosed as acute coronary syndromes (ACS) and underwent successful PCI with drug-eluting stent (DES) and conducted a follow-up coronary angiography in Center for Cardiovascular Diseases of Meizhou People’s Hospital at the period of January 1st, 2016 to January 1st, 2021 were included for analysis. The clinical and angiographic factors were compared between patients in ISR ( +) and ISR (−) groups. The association between variables and ISR was evaluated by multivariate logistic regression model.

Result

A total of 341 ACS patients who had been installed at least 1 stent were included in this study. The follow-up time was 34.2 ± 17.2 months. During the follow-up period, 62 (18.2%) patients experienced ISR, and the average time for ISR was 32.8 months; the incidence of ISR for left main coronary artery, left anterior descending coronary artery, left circumflex artery coronary artery and right coronary artery were 6.7%, 20.9%, 19.4% and 14.4%, respectively; left ventricular ejection fraction (LVEF), stent number, stent type, statin therapy, antiplatelet therapy were significantly different between patients in ISR ( +) and ISR (−) group. Multivariate logistic analysis suggested that LVEF and stent number were significantly correlated with ISR.

Conclusion

Our study revealed the incidence and risk factors of ISR in patients from southern China. Our data suggested that LVEF and stent number were independent risk factors associated with ISR.

The Impact of Lesion Complexity and the CHA2DS2-VASc Score on Spontaneous Reperfusion in Patients with ST-Segment Elevation Myocardial Infarction

BACKGROUND

In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography is defined as spontaneous reperfusion (SR).

OBJECTIVE

The present study aimed to determine the impact of lesion complexity and the CHA₂DS₂-VASc score on SR in patients with STEMI.

METHODS

A total number of 1,641 consecutive patients with STEMI undergoing primary PCI were assessed for this study. Patients were divided into 2 groups, those with SR, SR(+) (n = 239), and those without SR, SR(-) (n = 1402), according to their initial angiography and SR status. CHA₂DS₂-VASc scores were calculated for all patients. The lesion complexity of coronary artery disease was assessed with the SYNTAX score.

RESULTS

The CHA₂DS₂-VASc and SYNTAX scores were significantly lower in the SR(+) group compared to the SR(-) (mean CHA₂DS₂-VASc, 1.36 ± 0.64 vs. 2.01 ± 0.80, p < 0.001; mean SYNTAX score, 15.51 ± 5.94 vs. 17.08 ± 8.29, p < 0.001). After the multivariate regression analysis, a lower CHA₂DS₂-VASc (OR = 0.288, p < 0.001), SYNTAX score (OR = 0.920, p=0.007), uric acid (OR = 0.868, p=0.005), CRP (OR = 0.939, p=0.001), BNP (OR = 0.998, p=0.004), and troponin (OR = 0.991, p=0.001) were independent predictors of SR. In-hospital mortality rates were significantly lower in the SR(+) group compared to the SR(-) (0% vs. 6.7%, p < 0.001).

CONCLUSION

Our study demonstrated that lesion complexity and the CHA₂DS₂-VASc score are independently associated with spontaneous reperfusion.

Assessment of the relationship between death and CHA2DS2-VASc score in peripheral artery disease

BACKGROUND

The CHA<inf>2</inf>DS<inf>2</inf>-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke, vascular disease, age 65-74 years, female gender) score is used to estimate thromboembolic risk in atrial fibrillation (AF). Current studies have shown that CHA<inf>2</inf>DS<inf>2</inf>-VASc score can predict adverse clinical outcomes in coronary artery disease, stroke, and many diseases irrespective of the presence of AF. The usefulness of CHA<inf>2</inf>DS<inf>2</inf>-VASc score in predicting mortality of peripheral arterial disease (PAD) patients is unknown. In this study, we aimed to evaluate the predictive value of the CHA<inf>2</inf>DS<inf>2</inf>-VASc score for mortality of PAD patients.

METHODS

A total of 396 patients diagnosed with PAD for the first time in our clinic between January 2010-July 2016 were included in this study. Patients were divided into two groups as deceased (group 1, N.=153) and living (group 2, N.=243). A ROC analysis was performed to determine if CHA<inf>2</inf>DS<inf>2</inf>VASc score could predict the death events among PAD patients. Kaplan-Meier analysis was used to evaluate the timing of death events in the two groups.

RESULTS

The mean ages of group 1 and group 2 were 76.6±0.81 and 66.5±0.83 (P=0.007), respectively. The CHA<inf>2</inf>DS<inf>2</inf>VASc scores of group-1 (4.37±0.1) and group 2 (2.96±0.9) were significantly different (P<0.001). A significant correlation between CHA<inf>2</inf>DS<inf>2</inf>VASc score and death was determined in Spearman correlation (R:0.454, P<0.001). According to multivariate cox regression analysis, CHA<inf>2</inf>DS<inf>2</inf>-VASc score [odds ratio (OR): 1.81 (95% CI: 1.42-2.30); P<0.001], Stroke [OR: 0.43 (95% CI: 0.21-0.85); P=0.016] and CRP [OR: 1.04 (95% CI: 1.01-1.06); P=0.002] were independent predictors of death.

CONCLUSIONS

The CHA<inf>2</inf>DS<inf>2</inf>VASc score is directly related with mortality in PAD patients. The CHA<inf>2</inf>DS<inf>2</inf>VASc score may be a useful and practical scoring method to identify high-risk patients, and further future studies are needed to assess the role of CHA<inf>2</inf>DS<inf>2</inf>VASc score in PAD.

Risk of new-onset atrial fibrillation after drug-eluting stent implantation in patients with stable coronary artery disease

BACKGROUND

New-onset atrial fibrillation (NOAF) is associated with adverse outcomes in patients with coronary artery disease (CAD). Although newer generation drug-eluting stents (NG-DESs) are more beneficial than bare-metal stents (BMSs) in reducing the risk of in-stent restenosis and revascularization, whether NG-DES implantation in patients with stable CAD reduces NOAF risk compared with BMS implantation remains unknown.

METHODS

This population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database. Propensity score matching was used to select 18,423 pairs of patients with stable CAD receiving NG-DES implantation and BMS implantation with similar baseline characteristics for evaluation. A competing risk model was used to evaluate the risk of NOAF between the NG-DES and BMS groups in which death was considered a competing risk.

RESULTS

After adjustment for patients' clinical variables, the use of NG-DESs was associated with a decreased risk of NOAF at 1-year follow-up (adjusted subdistribution hazard ratio [SHR] = 0.79, 95% confidence interval [CI] = 0.68-0.93, P = 0.005) compared with the use of BMSs. Similar results indicated that NG-DESs were beneficial for reducing the risk of NOAF (adjusted SHR = 0.81, 95% CI = 0.67-0.97, P = 0.020) in patients with a CHA₂DS₂-VASc score of ≥2. These findings were also consistent with those for patients who received dual antiplatelet therapy for an undefined duration of >1 month following stent implantation.

CONCLUSIONS

Our findings suggest that NG-DESs might reduce the risk of NOAF in patients with stable CAD.

CHA2DS2-Vasc score and CHA2DS2-Vasc-HS score are poor predictors of in-stent restenosis among patients with coronary drug-eluting stents

Objective

To evaluate the ability of two scoring systems (CHA₂DS₂-VASc score and CHA₂DS₂-VASc+hyperlipidaemia+smoking [CHA₂DS₂-VASc-HS score]) to predict in-stent restenosis (ISR) among patients undergoing drug-eluting stent (DES) implantation.

Methods

This retrospective study enrolled patients who underwent coronary angiography to assess coronary artery disease severity secondary to a diagnosis of stable angina or acute coronary syndrome that subsequently underwent DES implantations. Demographic, clinical, angiographic and biochemical parameters were compared between those patients that experienced ISR and those that did not during the study follow-up period. Univariate and multivariate logistic regression analyses were used to evaluate associations between the baseline parameters, the two scoring systems and ISR risk.

Results

A total of 358 patients (non-ISR group n = 316; ISR group n = 42) participated in the study. Compared with the non-ISR group, more patients in the ISR group had diabetes mellitus and received stents with smaller diameters but longer lengths. There were no significant differences with regard the predictive ability for ISR of either the CHA₂DS₂-Vasc or the CHA₂DS₂-Vasc-HS scores. Multivariate logistic regression analyses demonstrated that stent diameter, follow-up duration and glycosylated haemoglobin were independent risk factors for ISR.

Conclusions

The CHA₂DS₂-Vasc and CHA₂DS₂-Vasc-HS scores did not predict ISR in patients after coronary DES placement.

Coronary angiography in worsening heart failure: determinants, findings and prognostic implications

Objectives

Coronary angiography is regularly performed in patients with worsening signs and/or symptoms of heart failure (HF). However, little is known on the determinants, findings and associated clinical outcomes of coronary angiography performed in patients with worsening HF.

Methods

The BIOSTAT-CHF (a systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) programme enrolled 2516 patients with worsening symptoms and/or signs of HF, either hospitalised or in the outpatient setting. All patients were included in the present analysis.

Results

Of the 2516 patients included, 315 (12.5%) underwent coronary angiography within the 30 days after the onset of worsening symptoms and/or signs of HF. Subjects who underwent angiography were more often observed as inpatients, had more often an overt acute coronary syndrome, had higher troponin I levels, were younger and had better renal function (all p≤0.01). Patients who underwent coronary angiography had a lower risk of the primary outcome of death and/or HF hospitalisation (adjusted HR=0.71, 95% CI 0.57 to 0.89, p=0.003) and death (adjusted HR=0.59, 95% CI 0.43 to 0.80, p=0.001). Among the patients who underwent coronary angiography, those with a coronary stenosis (39%) had a worse prognosis than those without stenosis (adjusted HR for the primary outcome=1.71, 95% CI 1.10 to 2.64, p=0.016).

Conclusions

Coronary angiography was performed in <13% of patients with symptoms and/or signs of worsening HF. These patients were remarkably different from those who did not undergo coronary angiography and had a lower risk of subsequent events. The presence of coronary stenosis on coronary angiography was associated with a worse prognosis.