Abstract
Revascularization of an initially non-target site due to its progression as a new culprit lesion has emerged as a new therapeutic target of coronary artery disease (CAD) in the era of drug-eluting stents. Using the Shinken database, a single-hospital-based cohort, we aimed to clarify the incidence and prognostic factors for progression of previously non-significant coronary portions after prior percutaneous coronary intervention (PCI) in Japanese CAD patients. We selected from the Shinken database a single-hospital-based cohort of Japanese patients (n = 15227) who visited the Cardiovascular Institute between 2004 and 2010 to undergo PCI. This study included 1,214 patients (median follow-up period, 1,032 ± 704 days). Additional clinically driven PCI to treat previously non-significant lesions was performed in 152 patients. The cumulative rate of new-lesion PCI was 9.5 % at 1 year, 14.4 % at 3 years, and 17.6 % at 5 years. There was no difference in background clinical characteristics between patients with and without additional PCI. Prevalence of multi-vessel disease (MVD) (82 vs. 57 %, p < 0.001) and obesity (47 vs. 38 %, p = 0.028) were significantly higher and high-density lipoprotein cholesterol (HDL) level (51 ± 15 vs. 47 ± 12 mg/dl, p < 0.001) was significantly lower in patients with additional PCI than those without. Patients using insulin (6 vs. 3 %, p = 0.035) were more common in patients with additional PCI. Multivariate analysis showed that MVD, lower HDL, and insulin use were independent determinants of progression of new culprit coronary lesions. In conclusion, progression of new coronary lesions was common and new-lesion PCI continued to occur beyond 1 year after PCI without attenuation of their annual incidences up to 5 years. Greater coronary artery disease burden, low HDL, and insulin-dependent DM were independent predictors of progression of new culprit coronary lesions.
Highlights
Drug-eluting stents have dramatically decreased stent restenosis and target lesion revascularization [1]
Progression of new coronary lesions was common and new-lesion percutaneous coronary intervention (PCI) continued to occur beyond 1 year after PCI without attenuation of their annual incidences up to 5 years
There were no difference in age, sex, traditional coronary risk factors including hypertension, diabetes mellitus, dyslipidemia, cigarette smoking, family history of coronary artery disease (CAD), and Chronic kidney disease (CKD)
Summary
Drug-eluting stents have dramatically decreased stent restenosis and target lesion revascularization [1]. Previous clinical studies validated the pathogenesis and risk factors for stent restenosis, suggesting that restenosis rates differed in patients’ clinical and angiographic characteristics such as diabetes mellitus, vessel size, lesion length, and repeated revascularization procedures after stent implantation [2,3,4]. This has provided us unresolved problems regarding revascularization of initially non-target site due to its progression as a new culprit lesion after percutaneous coronary intervention (PCI).
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