Prognostic determining factors outcome after PCI in patients with diabetes mellitus

Abstract

Aim. The present study was designed 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 outcome after percutaneous coronary interventions (PCI) in patients with stable coronary artery disease (SCAD) on dual antiplatelet therapy (DAPT).Methods. A prospective, single-center study included 94 patients with SCAD who underwent PCI with DES implantation, 20% had diabetes mellitus. Platelet reactivity was determined in all patients using light transmission aggregometry induced with 5μmol/L ADP (LTA-ADP) and VerifyNow before PCI, as well as CYP2C19 genotyping. In 74 patients were determined baseline levels of high-sensitivity C-reactive protein, soluble P-selectin, soluble CD40 ligand, highly sensitive IL-6, plasminogen activator inhibitor-1 levels and von Willebrand factor activity. Mean follow-up period was 28,2±15,5 months. Cumulative endpoint included major adverse cardiac event, stent thrombosis, angina recurrence or angiographically confirmed restenosis.Results. According to univariate regression analysis we revealed that diabetes mellitus [exp (B) 0,344 95% CI 0,118-1,004, p=0,049], PRU [exp (B) 1,009; 95% CI 1,002-1,017, p=0.01], number of stented arteries [exp (B) 4,00; 95% CI 1,475-10,848, p=0.01], number of implanted stents [exp (B) 3,672; 95% CI 1,366-9,872, p=0.01], baseline levels of PAI-1 [exp (B) 1,000, 95% CI 0,999-1,000, p=0.03] and von Willebrand activity [exp (B) 1,000, 95 1,000-1,000% CI, p=0.01]. The presence of CYP2C19*2 carriers revealed no significant impact on outcome after PCI. Using ROC-curve analysis to determine cutoff values for PRU was 202 (AUC 0,664; 95%CI 0,531-0,796, р=0,02), PAI-1 level - 75,95 ng/ml, (AUC 0,726, 95%CI 0,576-0,876, р=0,01), von Willebrand factor activity – 155,5% (AUC 0,724, 95%CI 0,561-0,887, р=0,01). Multivariate analysis revealed that concomitant diabetes mellitus, PRU ≥202, PAI-1 level ≥75.95 ng/ml, von Willebrand factor activity ≥155.15% are independent predictors of adverse cardiac events. Based on our findings we developed predictive models for risk stratifying of patients with CAD before PCI.Conclusions. Present study reveals following independent predictors of adverse cardiac events in patients with SCAD after PCI: concomitant diabetes mellitus, the value of PRU (≥202), the level of plasminogen activator inhibitor-1 (≥75.95 ng/ml) and von Willebrand factor activity (≥155.15%).