A predictive model involving serum uric acid, C-reactive protein, diabetes, hypercholesteremia, multiple lesions for restenosis risk in everolimus-eluting stent-treated coronary heart disease patients

Abstract

PurposeAs a second-generation drug-eluting stent, the restenosis risk factors of the everolimus-eluting stent (EES) lack sufficient evidence. Therefore, the study investigated the in-stent restenosis occurrence and its predictive factors among patients with coronary heart disease (CHD) who underwent percutaneous coronary intervention (PCI) with EES.Materials and methodsTotally, 235 patients with CHD who underwent PCI with EES were included. At 1 year post PCI with EES (or earlier if clinically indicated), coronary angiography was performed to evaluate the in-stent restenosis status.ResultsWithin 1 year post-operation, 20 patients developed in-stent restenosis while 215 patients did not develop in-stent restenosis, resulting in a 1-year in-stent restenosis rate of 8.5%. Diabetes mellitus, hypercholesteremia, hyperuricemia, fasting blood glucose, serum uric acid (SUA), high-sensitivity C-reactive protein (HsCRP), target lesions in the left circumflex artery, patients with two target lesions, length of target lesions and length of stent positively correlated with in-stent restenosis risk, while high-density lipoprotein cholesterol negatively associated with in-stent restenosis risk. Notably, diabetes mellitus, hypercholesteremia, SUA, HsCRP levels, and patients with two target lesions were independent predictive factors for in-stent restenosis risk by multivariate logistic regression analysis. Then, the in-stent restenosis risk prediction model was established based on these independent predictive factors, which exhibited an excellent value in predicting in-stent restenosis risk (area under the curve: 0.863; 95% CI: 0.779–0.848) by receiver operating characteristic analysis.ConclusionIn-stent restenosis risk prediction model, consisting of diabetes mellitus, hypercholesteremia, SUA, HsCRP, and patients with two target lesions, may predict in-stent restenosis risk in patients with CHD who underwent post-PCI with EES.

Correlation between SUA and prognosis in CHF patients after revascularization

“…Physicians consider a combination of these factors, but because each patient's situation is unique, prognosis assessment needs to be individualized and closely monitored. In the past, many studies have said that [5] [6] changes in serum uric acid (SUA) levels are independently related to the incidence rate and mortality of cardiovascular diseases, and some studies have also shown that [7] Hyperuricemia (HUA) is associated with poor prognosis of elderly CHF, and the risk of rehospitalization of patients with HUA is significantly increased. Moreover, SUA can also cause inflammatory and oxidative stress reactions.…”

Progress of uric acid in cardiovascular disease

“…In addition, SUA has been demonstrated to be an independently related marker for an elevated risk of stent restenosis after PCI. When combined with diabetes, hypercholesterolemia, hs-CRP and lesions in multiple target regions, SUA can form a prediction model for the risk of in-stent restenosis in individuals with CAD undergoing PCI [ 55 ]. Likewise, SUA has been demonstrated to be an independently predictive risk marker for MACE and the presence of multiple coronary lesions 1–3 years after PCI in individuals with ACS and hypertension [ 56 ].…”