Abstract
BackgroundThere have been limited data on the impact of hyperuricemia on long-term clinical outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR).MethodsFrom January 2009 to July 2015, 317 patients who underwent repeat PCI for ISR were divided into two groups: patients with normal serum uric acid (UA) levels (normal UA group) and patients with higher serum UA levels (higher UA group). The higher UA group included patients with serum UA levels > 6.8 mg/dL or patients who were taking anti-hyperuricemic medication.ResultsDuring a median follow-up period of 1088 days, the cumulative incidence rates of major adverse event (MAE), including a composite of all-cause death, non-fatal myocardial infarction, and any revascularization, were similar between the two groups (higher UA 36.4% vs. normal UA 29.9%, p = 0.389, log-rank p = 0.367). Follow-up angiographic data showed similar outcomes of late lumen loss (0.8 ± 0.9 mm vs. 0.8 ± 1.1 mm, p = 0.895) and binary restenosis rate (28.1% vs. 34.7%, p = 0.622). Multivariate Cox regression analysis indicated higher levels of low-density lipoprotein cholesterol (hazard ratio [HR] 1.011, 95% confidence interval [CI] 1.003–1.019, p = 0.006) and lower left ventricular ejection fraction (HR 0.972, 95% CI 0.948–0.996, p = 0.022), but not UA levels, to be the independent risk predictors of MAE.ConclusionHyperuricemia is not associated with poor clinical outcomes after repeat PCI for ISR lesions.
Highlights
There have been limited data on the impact of hyperuricemia on long-term clinical outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR)
Receiver-operating characteristic curve analysis of serum uric acid (UA) level for major adverse event (MAE) in the present study showed an area under the curve of 0.544 (95% confidence interval 0.474–0.615, data not shown)
HR, hazard ratio; 95% CI, 95% confidence interval; NSTEMI, non-ST segment elevation myocardial infarction; STEMI, ST segment elevation myocardial infarction; low-density lipoprotein (LDL)-C, low density lipoprotein cholesterol; LVEF, left ventricular ejection fraction; Drug-eluting stent (DES), drug-eluting stent; CTO, chronic total occlusion; ISR, in-stent restenosis; DCB, drug-coated balloon groups determined using the median UA level (5.3 mg/ dL), the results showed similar clinical outcomes between patients with lower UA level (≤5.3 mg/dL) and patients with higher UA level (> 5.3 mg/dL) (Additional File 1: Table S4 and Additional File 1: Figure S1)
Summary
There have been limited data on the impact of hyperuricemia on long-term clinical outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR). Long-term follow-ups of previous large clinical trials on first-generation DES showed an annual ISR rate of approximately 6–8% [2,3,4]. Many clinical studies reflecting real-world situations, such as complex lesion interventions and high-risk patient populations, reported higher rates of ISR [5, 6]. The appropriate treatment for ISR lesions, especially after DES implantation, still remains debatable, repeat percutaneous coronary intervention (PCI). ISR is considered to be an intrinsic cellular and biological response after stent implantation. A recent study showed that high-sensitivity C-reactive protein (hsCRP) was associated with ISR and poor clinical outcomes after DES implantation [13]. Other studies suggested different circulating inflammatory biomarkers as risk predictors
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