Analysis Of Risk Factors For Repeat Revascularization In Patients With Premature Coronary Artery Disease After PCI

backgroundThe number of people with coronary heart disease is rapidly increasing worldwide.The prevention and treatment of coronary heart disease in China has significantly improved in the last decade,however,there is still much to be done in this area.The number of patients with coronary artery disease in China is estimated to 1 million,and coronary heart disease is the leading cause of death both in the urban and rural areas.More importantly,coronary heart disease is becoming also prevalent among young people.Premature coronary artery disease(PCAD)is defined as the development of coronary artery disease in<55 and<65 years-old men and women,respectively.Compared with coronary artery bypass grafting(CABG),percutaneous coronary intervention(PCI)causes less trauma and requires a shorter postoperative recovery period,it’s less costly and without ugly scars.For these reasons,most patients with PCAD prefer PCI as a way of revascularization.However,contrary to the above advantages,complete revascularization is not often achieved with PCI,and there are still risks of in-stent restenosis and in-stent thrombosis,which are important reasons that cause patients to receive repeat revascularization after PCI.The prognosis of PCAD patients after PCI is usually better,compared with older patients with coronary heart disease.However,there are still some patients who undergo repeat revascularization within a short period after PCI.This not only increases the perioperative risk but also the economic burden.The risk factors for repeat revascularization after PCI in these high-risk PCAD patients are still unknown.ObjectiveThis study aimed to explore the risk factors for repeat revascularization in PCAD patients within 2 years after PCI and provide a basis for clinical screening of high-risk patients.MethodA total of 310 patients who were diagnosed with premature coronary artery disease and received PCI during the hospitalization in the Department of Cardiology from January 2017 to December 2017 were enrolled.The occurrence of the repeat revascularization within 2 years after PCI was observed and recorded.We divided patients into repeat revascularization and control groups,according to whether repeat revascularization occurred during the follow-up period.The differences in clinical baseline data and surgical data between the two groups were compared.The binary multivariate logistic regression analysis was used to explore the risk factors for revascularization in PCAD patients within 2 years after PCI.We used the receiver operating characteristic curve(ROC)to evaluate the predictive value of risk factors for repeat revascularization.Result1.Within 2 years after PCI,64 out of 310 patients(20.65%)received repeat revascularization therapy.The remaining 246 patients had no clinical coronary ischemic events,target lesion restenosis,or non-target lesions.progress.Of the 64 patients in the repeat revascularization group,13(20.31%)received revascularization within 6 months,27(42.18%)received revascularization within 1 year,and 24(37.50%)Revascularization treatment was performed again within 2 years;62 cases(96.88%)received re-PCI treatment during revascularization,2 cases(3.12%)received CABG surgery;30 cases(46.87%)received target lesion revascularization,Twenty-nine cases(45.31%)received non-target disease revascularization,and 5 cases(7.81%)received both target disease and non-target disease treatment.2.Baseline clinical data of the two groups showed that in the revascularization group,fasting blood glucose[(5.63±1.75mmol/L)vs(5.11±1.65mmol/L),P=0.024],platelet count[(207.42±46.05)×109/L vs(192.27±55.27)×109/L,P=0.044],TC/HDL-C[(4.25±1.14)vs(3.24±1.09),P<0.001],uric acid[(324.28 ±78.95μmol/L)vs(260.10±78.99μmol/L),P<0.001]were higher than those in the control group,and the difference was statistically significant.There was no statistical significance in gender composition,age,smoking history,family history of coronary heart disease,hypertension,diabetes,HbAlc,TG,HDL-C,LDL-C,creatinine,glomerular filtration rate,left ventricular ejection fraction,left ventricular end-diastolic dimension and medication between two groups(P>0.05).3.The first PCI data of the two groups of patients showed that the proportion of patients in the repeat revascularization group with small vessel disease was higher(34.37%vs 20.73%,P=0.022),and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups in terms of the number of coronary artery diseased blood vessels,the location of the disease,and the number of implanted stents(P>0.05)4.The results of binary Logistic regression showed that TC/HDL-C(OR=3.199,95CI%2.068～4.949,P<0.001),uric acid(OR=1.011,95CI%1.007～1.015,P<0.001)and small vessel disease(OR=3.449,95CI%1.611～7.386,P=0.001)were independent risk factors for the occurrence of repeat revascularization.5.ROC curve analysis results show that the area under the TC/HDL-C index curve is 0.728(95%CI 0.663～0.792).When the sensitivity is 95.3%and the specificity is 38.6%,the maximum diagnostic index is 0.339,and the diagnostic efficiency is better.The corresponding diagnostic cut-off point is 2.945;the area under the uric acid index curve is 0.712(95%CI 0.643～0.782).When the sensitivity is 53.1%and the specificity is 77.2%,the maximum diagnostic index is 0.304.The diagnostic efficiency is better.The diagnostic cut-off point is 320.500;the area under the curve of small vessel disease index is 0.568(95%CI 0.487～0.650),and the diagnostic index is 0.136 when the sensitivity is 34.4%and the specificity is 79.3%.ConclusionWe observed that the elevated uric acid,elevated TC/HDL-C ratio,and small vessel disease are independent risk factors for repeat revascularization in PCAD patients after PCI.