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Lesion characteristics,risk factors and prognostic analysis of coronary small vessel disease:A retrospective study of 986 patientsBackground and aims:The incidence of coronary small vessel disease has been more and more frequent and many studies have showed that patients with small vessel disease are often combined with more complications,complex lesions,difficulties in PCI and poorer long-term prognosis.However,some studies have demonstrated that the long-term prognosis of small vessel disease is the same as non-small vessel disease.Most of the current research are from the European and American population,while few research is in Chinese population.Therefore,we designed this retrospective study to clarify the characteristics,risk factors and prognostic analysis of coronary small vessel disease,which will help early identification of high-risk patients to make better treatment plan and strengthen the follow-up management in order to improve the prognosis.Methods:986 patients underwent coronary angiography and stent implantation in 2015 at the First Affiliated Hospital of Zhejiang University School of Medicine were included.Patients were grouped into two categories according to diameter of implanted stents:those of small vessel disease(stent diameter ?2.5mm,308 patients)and those of non-small vessel disease(stent diameter>2.5mm,678 patients).We collected information of pre-PCI basic clinical characteristics,angiographic results and intervention procedure,post-PCI medicine therapy,and long-term follow-up.Multivariate logistic regression was used to identify independent risk factors for small vessel disease and restenosis after PCI.Kaplan-Meier method was used to plot the cumulative MACE-free survival curve and the log-rank test was used to check the difference of the MACE-free survival curve between the two groups.Cox regression model was used to explore possible varieties that had affection to all CAD patients and small vessel disease patients on MACE and revascularization events,and to figure out the independent predictor factors.Results:Aging(OR=1.022,95%CI:1.009-1.036,P=0.001),diabetes mellitus(OR=1.742,95%CI:1.278-2.373,P<0.001),peripheral vascular disease(OR=2.484,95%CI:1.487-4.148,P<0.001),higher low-density lipoprotein(LDL)(OR=1.245,95%CI:1.060-1.461,P=0.007),and higher homocysteine level(OR=1.017,95%CI:1.002-1.033,P<0.001)were the independent risk factors of small vessel disease,while alcoholic-intake history might be the protective factor.Left circumflex lesions were observed much more in patients with small vessel disease(31.9%vs 17.3%,P<0.001),and were more likely to associate with multi-vessel lesion(79.2%vs 49.4%,P<0.001),bifurcation lesion(24.0%vs 12.4%,P<0.001),chronic total obstruction(CTO)lesion(29.5%vs 9.4%,P<0.001),and diffusing lesion(55.2%vs 35.7%,P<0.001),which caused worse efficacy of revascularization therapy(70.1%vs 85.1%,P<0.001).During PCI,pre(95.8%vs 68.7%,P<0.001)and post(94.2%vs 89.4%,P=0.016)dilation were much usual in patients with small vessel disease.During follow-up,cardiac death(2.3%vs 0.4%,P=0.008),stroke(1.9%vs 0.3%,P=0.007),TLR(5.8%vs 2.9%,P=0.029),TVR(6.8%vs 3.4%,P=0.016),non-target vessel revascularization(7.8%vs 4.0%,P=0.012)were much higher in patients with small vessel disease.Complete revascularization was a protective factor(OR=0.351,95%CI:0.136-0.901,P=0.029)to restenosis after PCI in patients with small vessel disease,while higher TSH level might be an independent risk factor(OR=1.203,95%CI:1.059-1.366,P=0.004).Heart rate(OR=0.952,95%CI:0.919-0.987,P=0.008),ventricular aneurysms(OR=8.750,95%CI:1.861-41.134,P=0.006),white blood cell count(OR=1.117,95%CI:1.001-1.246,P=0.049),TSH level(OR=1.158,95%CI:1.046-1.282,P=0.005),post-dilatation(OR=0.223,95%CI:0.063-0.782,P=0.019),IVUS/OCT(OR=4.772,95%CI:1.666-13.66,P=0.004),intraoperative blood loss(OR=1.016,95%Cl:1.004-1.028,P=0.009),complete revascularization(OR=0.405,95%CI:0.169-0.971,P=0.043),aspirin taking(OR=0.101,95%CI:0.015-0.685,P=0.019)were the independent predictors of MACE in patients with small vessel disease by Cox regression analysis.While Chest pain(OR=5.117,95%CI:1.206-21.723,P=0.027),cardiac function(OR=1.622,95%CI:1.049-2.507,P=0.030),heart rate(OR=0.959,95%CI:0.934-0.986,P=0.002),stroke history(OR=3.535,95%CI:1.153-10.834,P=0.027),bifurcation lesion(OR=3.047,95%Cl:1.499-6.196,P=0.002),complete revascularization(OR=0.329,95%CI:0.169-0.641,P=0.001)were the independent predictors of revascularization in patients with small vessel disease.Conclusion:This analysis concluded some clinical and angiographic characteristics which were similar to studies published before and we found alcoholic-intake history might be the possible protective factor to coronary small vessel disease.Higher TSH level was seemed to be the independent risk factor to restenosis after PCI in patients with small vessel disease,while complete revascularization was the independent protective factor.Ventricular aneurysms,higher levels of WBC,higher levels of TSH,intraoperative use of IVUS/OCT and more intraoperative blood loss were the independent risk factors for MACE in patients with coronary artery disease,whereas higher heart rate,post-dilatation,complete revascularization and aspirin taking were the independent protective factors.Chest pain,poor cardiac function,stroke history and combined with bifurcation lesions were the independent risk factors for revascularization in patients with coronary artery disease,whereas higher heart rate and complete revascularization were the independent protective factors.Part ? Efficacy of different drug-eluting stents in patients with coronary small vessel disease:A Systematic Review and Meta-AnalysisBackground and objectives:For patients with coronary small vessel disease,percutaneous coronary intervention(PCI)was the recommended strategy,however the choice of drug-eluting stents(DES)remains controversial.This meta-analysis aims to compare the efficacy of limus-eluting stent(LES)with paclitaxel-eluting stent(PES)in coronary artery disease(CAD)patients caused by small vessels.Methods:The PubMed,Cochrane Central Register of Controlled Trials and Web of Science were searched until March 2017 comparing the clinical outcomes of implanting LES with PES in CAD patients caused by small vessels.Relative risk(RR)estimates with 95%confidence intervals were calculated using fixed effect model.Results:A total of 8 studies involving 4,738 patients were included in our meta-analysis.Compared with PES,LES implantation was associated with significant reduction in major adverse cardiovascular events(MACE)(RR:0.64,95%CI:0.53-0.77;P<0.00001;I2=39%),myocardial infarction(MI)(RR:0.61,95%CI:0.45-0.82;P=0.001;I2=0%),stent thrombosis(ST)(RR:0.22,95%CI:0.13-0.37;P<0.00001;I2=6%),and target lesion revascularization(TLR)(RR:0.56,95%CI:0.44-0.71;P<0.00001;I2=7%),while no difference was observed in all cause death(RR:0.98,95%CI:0.65-1.48;P=0.92;I2=0%),cardiac death(RR:1.08,95%CI:0.62-1.88;P=0.80;I2=23%),and target vessel revascularization(TVR)(RR:0.80,95%CI:0.45-1.44;P=0.46;I2=54%).Conclusions:In CAD patients caused by small vessels who are undergoing PCI,treatment with LES has a greater efficacy than PES in reducing the risk of adverse cardiovascular events. |
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