Factors determining the prognosis after elective myocardial revascularization in patients with coronary artery disease with multifocal atherosclerosis

Abstract

Aim. To identify factors determining the prognosis after elective myocardial revascularization in patients with coronary artery disease (CAD) with multifocal atherosclerosis (MFA).Material and methods. The study is based on the prospective registry REGATA-1, ClinicalTrials NCT04347200 (1500 patients with stable coronary artery disease; men, 78,6%, age, 65±8,7 years). We selected 238 patients with MFA, the criteria of which were multivessel CAD (at least 2 arteries) in combination with stenosis ≥50% of at least one of the peripheral vascular system. The selection criteria was elective myocardial revascularization followed by dual antiplatelet therapy for at least 6-12 months. Unfavorable outcomes were analyzed, namely thrombotic events (TEs) in any vascular system and bleeding (BARC type 2-5).Results. The median follow-up was 859 days (interquartile range [523;1665]). Thrombosis dominated in the structure of events: the total incidence of TEs was 18,5% (including fatal — 4,2%), and the total incidence of bleeding was 7,5% (including BARC type 3 — 1,7%). Predictors of TE were smoking (hazard ratio (HR)=2,18), myocardial infarction (HR=2,6) and ischemic stroke/transient ischemic attack (HR=2,81) more than a year ago, as well as revascularization with percutaneous coronary intervention (PCI) versus coronary artery bypass grafting. For PCI, the prognosis was worse in case of incomplete revascularization, as well as when the intervention was limited to ≤2 arterial segments and the total length of stents <26 mm. Among all predictors of poor prognosis, the most significant was high-risk PCI in combination with dual antiplatelet therapy for <12 months (HR=6,7).Conclusion. For the first time, TE predictors in patients with CAD and MFA have been identified, which will improve secondary prevention in a category of patients with an extremely high risk of TEs.