Independent Predictors of Major Adverse Events following Coronary Stenting over 28 Months of Follow-Up

Abstract

Background: Despite recent advances in stent design and constantly improving protective pharmacological strategies, complications and adverse events following percutaneous coronary interventions (PCI) are still major factors influencing morbidity and mortality. Therefore, predicting secondary vascular occlusions represents an unmet medical need. Objective: The aim of our study was to triage clinical and laboratory predictors of major adverse clinical events (MACE) following coronary stenting. Methods: This was a prospective, case-controlled, single-center study, which included 94 consecutive patients with documented coronary disease who underwent PCI with drug-eluting stent (DES) implantation. All patients received dual antiplatelet therapy with aspirin and clopidogrel. Numerous clinical characteristics and laboratory biomarkers were assessed before stenting and were correlated with poststenting MACE over the mean follow-up of 28 months. MACE included death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and instent restenosis. Results: Twenty-three patients experienced MACE. Independent MACE predictors after PCI with DES implantation were antecedent diabetes mellitus (RR = 0.45; 95% CI 0.20-0.97; p = 0.045), prior thrombolytic therapy (RR = 0.42; 95% CI 0.27-0.83; p = 0.039), baseline plasminogen activator inhibitor -1 (PAI-1; p = 0.008) and plasma von Willebrand factor (vWF) activity (p = 0.007). Other clinical characteristics and laboratory indices showed no correlation with MACE. Conclusions: Background diabetes mellitus, prior thrombolytic therapy, PAI-1 and vWF prestenting activity may be useful for MACE prediction over 28 months of follow-up.

Recurrent Event Analysis of Coronary Artery Stenosis in Patients Undergoing Angioplasty

“…In this study, the effect of the history of diabetes was significant on restenosis; it is similar to many previously conducted studies (19)(20)(21). However, some studies argued that the effect of diabetes was not significant on restenosis (22,23).…”

Factors Influencing Stent Restenosis After Percutaneous Coronary Intervention in Patients with Coronary Heart Disease: A Clinical Trial Based on 1-Year Follow-Up

“…Diabetes is now recognized as an independent risk factor for CAD in CHD patients and is also a risk factor for ISR after PCI. The long-term hypercoagulable state, vascular endothelial metabolism, and dysfunction of coronary artery blood flow in diabetic patients can increase the risk of thrombosis [32–34]. Insulin can activate some growth factors to promote intimal hyperplasia, vascular smooth muscle cell proliferation and migration, and extracellular matrix deposition, and accelerate the formation of restenosis [35,36].…”

Impact of statin therapy on plasma levels of plasminogen activator inhibitor-1

“…In, a recent meta-analysis of Wu et al, that included more than 22,000 patients with atrial fibrillation from 27 cohort and case-control studies, PAI-1 levels were significantly higher in patients who developed a thromboembolic stroke (35). In prospective and case-control studies PAI-1 levels were associated with both the risk of an acute myocardial infarction (36) and its recurrence after a first event (37). PAI-1 was also shown to be a strong and independent predictor for 30-day mortality in patients with an acute ST segment elevation myocardial infarction (38).…”