Abstract
Diabetes Mellitus, High Platelet Reactivity and Endothelial Dysfunction Determine the Outcomes after PCI. Elena Z. Golukhova, Marina V. Grigoryan, Maria N. Ryabinina, Naida I. Bulaeva. Department of Noninvasive Cardiology, Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia. Table. Objective: The purpose of our study was to evaluate the prognostic value of platelet reactivity, initial level of inflammation markers and endothelial dysfunction, as well as CYP2C19*2 allele carriage in clinical outcomes after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (SCAD) during dual antiplatelet therapy (DAPT). Methods: A prospective, single-center study included 94 patients with SCAD who underwent PCI with DES implantation. Platelet reactivity was determined in all patients using light transmission aggregometry induced with 5mmol/L ADP (LTA-ADP) and VerifyNow before PCI, as well as CYP2C19 genotyping after patient’s discharge. In 74 patients were determined baseline levels of highsensitivity C-reactive protein, soluble P-selectin, soluble CD40 ligand, highly sensitive IL-6, PAI-1 levels and von Willebrand factor activity. Results: According to univariate regression analysis we revealed that diabetes mellitus [exp (B) 0,344 95% CI 0,118-1,004, p1⁄40,049], PRU [exp (B) 1,009; 95% CI 1,002-1,017, p1⁄40.01], the number of stented arteries [exp (B) 4,00; 95% CI 1,475-10,848, p1⁄40.01], the number of implanted stents [exp (B) 3,672; 95% CI 1,366-9,872, p1⁄40.01], the initial level of PAI-1 [exp (B) 1,000, 95% CI 0,999-1,000, p1⁄40.03] and the activity of EF [exp (B) 1,000, 95 1,000-1,000% CI, p1⁄40.01]. The presence of CYP2C19*2 carriers showed no significant impact on outcomes after PCI. For quantitative factors we built ROC-curves to determine their critical values. Independent significant influence showed concomitant diabetes mellitus, PRU> 1⁄4202, PAI-1 level> 1⁄4 75.95 ng / ml, von Willebrand factor activity> 1⁄4 155.15%. Based on our findings we developed predictive models for risk stratifying of patients with CAD before PCI. Conclusions: The independent predictors of adverse cardiac events after PCI were: concomitant diabetes mellitus type 2, the value of PRU ( 202), the level of plasminogen activator inhibitor-1 ( 75.95 ng / ml) and von Willebrand factor activity( 155.15%).
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