PREDICTORS OF THE MAJOR CARDIOVASCULAR EVENTS IN THE EARLY AND MIDDLE-LONG TERM AFTER PERCUTANEOUS CORONARY INTERVENTION

Abstract

Objective: To estimate predictors for major adverse cardiovascular events (MACE) in the early and middle-late periods after percutaneous coronary interventions (PCI). Design and method: The study included 116 patients (85% men and 15% women) with coronary artery disease (CAD) after PCI. In the early and middle-long-term periods MACE was developed in 24% of patients. The analysis of MACE predictors included wide range of clinical,angiographic,instrumental parameters,factors associated with the functions of the endovascular procedure,genetic testing. Results: There was not found predictive value of known risk factors, such as the presence of diabetes mellitus (DM) type II (OR = 1.75; 95% CI:0.54–4.62), smoking (OR = 1.51; 95% CI:0.64–3.56), hypertension (OR = 1.48; 95% CI:0.56–3.86), obesity (OR = 2.37; 95% CI:0.98–5.71), burdened heredity for CAD (OR = 2.16; 95% CI:0.85–5.48), a combination of several risk factors (DM+smoking) (OR = 2.17; 95% CI:0.65–7.28),DM+AH+obesity (OR = 2.97; 95% CI:0.83–10.61), chronic heart failure (OR = 1.7; 95% CI:0,53–5.46) on the risk of developing of MACE after PCI. It was found that significant MACE predictors in the early term period after PCI were: increased platelet reactivity in the presence of dual antiplatelet therapy (OR = 11.0; 95% CI:1.09–110.5) and carriage of polymorphic alleles of the fibrinogen-beta gene: alleles T (rs1800787) (OR = 4.7; 95% CI:1.07–20.2), alleles A (rs2227401) (OR = 4.9; 95% CI:1.12–21.1), alleles C (rs20426442) (OR = 4.9; 95% CI:1.12–21.1), in the middle-long term period: increased residual platelet reactivity despite of DAPT (OR = 11.67; 95% CI:4.29–31.71), decreased Antithrombin-III activity before and/or after PCI (OR = 5,5; 95% CI:1.4–21.68), SYNTAX Score > 22 (OR-4.53; 95% CI:1.26–16.23), non-drug-eluting stent implantation (OR = 3,24; 95% CI:1.12–9.41), DAPT score > 2 (OR = 3.15; 95% CI:1.3–7.64), the presence of multifocal atherosclerosis (OR = 2.91; 95% CI:1.15–7.39), LVEF < 35% (OR = 2.52; 95% CI:1.05–6.03). Conclusions: Predictors of MACE in the early term after PCI were:increased residual platelet and the presence of genetic fibrinogen abnormalities, after middle-long term-increased residual platelet, failure to achieve the target lipid profile, decreased activity Antithrombin-III before and/or after PCI, SYNTAX Score > 22, implantation of non-drug-eluting stents, DAPT score > 2, presence of multifocal atherosclerosis, LVEF < 35%. The frequency of known clinical risk factors, such as smoking, hypertension, DM, physical inactivity, obesity, burdened heredity for CAD, in the group of MACE patients was slightly higher, but did not reach statistical significance.