Factors influencing the outcomes of coronary artery stenting with everolimus-eluting stents in acute coronary syndromes without ST segment elevation

Abstract

Introduction. Percutaneous interventions used in the treatment of acute coronary syndrome (ACS) may be complicated by the recurrence of the ischemia clinical picture due to the late lumen loss of the stent. Factors influencing the risk of the restenosis developing may differ depending on the clinical situation and stent characteristics.Objective. To identify risk factors for repeated revascularization in patients with ACS without ST-segment elevation after placement of everolimus-eluting stents. Materials and methods. The study included 126 patients with ACS, who received platinum-chromium containing everolimus-eluting stents. The main clinical and laboratory parameters of the patients were analyzed. After 12 months, the combined endpoint (death, myocardial infarction in the basin of the stented artery, repeated revascularization of the stented vessel) was assessed.Results. During the followup, 18 of 126 patients (14.3 %) reached the combined endpoint. Among patients who reached the endpoint, there were more women (10 (24.4 %) and 8 (9.4 %); p=0.02). In patients who reached the endpoint, the level of highly sensitive troponin was significantly higher (0.032 (0.007; 0.32) ng/ml versus 0.005 (0.002; 0.022) ng/ml; p=0.005), there was a lower left ventricular ejection fraction (52.2±12.3 % vs 58.6±8.9 %; p=0.02) and glomerular filtration rate (68.5±15.7 ml/min vs 76.3±18.2 ml/min; p=0.04), and there was also a significantly lower level of triglycerides (1.3±0.4 mmol/L and 1.8±0.9 mmol/L, p=0.004) and VLDL (0.6±0.2 mmol/L and 0.8±0.4 mmol/L, p=0.006). According to multivariate regression analysis, the leading factors influencing the risk of repeated revascularization were diabetes mellitus (OR 4.25; 95 % CI: 1.12–16.15; p=0.03), glomerular filtration rate and triglyceride level (OR 0.25; 95 % CI: 0.07–0.93; p=0.03).Conclusions. When using everolimus-eluting stents, diabetes mellitus, decreased glomerular filtration rate and low blood triglyceride levels are among the main factors affecting the risk of in-stent restenosis.