Prognostic factors for stent restenosis in patients with coronary artery disease undergoing percutaneous coronary intervention

Aim. To study the relationship between plasma levels of lipoprotein(a) (Lp(a)), vascular endothelial growth factor (VEGF), transforming growth factor β (TGF-β), and the occurrence of stent restenosis after percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD), as well as the achievement of target low-density lipoprotein cholesterol level with lipid-lowering therapy.

Material and methods. The prospective study included 92 patients (mean age 64.0 years, 79.5% male, 20.5% female) diagnosed with acute coronary syndrome (ACS) who underwent stenting of a clinically significant or infarction-related coronary artery. At the same time, blood flow in the remaining coronary arteries was visually assessed during selective coronary angiography (SCA). In cases of hemodynamically significant stenosis of a coronary artery not associated with ACS, ranging from 70% to 90%, the patient was invited to consult a cardiologist in a month to decide on myocardial revascularization through stress testing, taking into account the patient’s clinical status (complaints). If necessary, repeat SCA for therapeutic purposes was performed after 1-2 months to visualize neointima formation and the degree of restenosis within the stent previously implanted in the infarct-related artery, in combination with the determination of Lp(a), VEGF, and TGF-β in blood plasma. The achievement of the target LDL-C level against the background of lipid-lowering therapy was assessed. Patients were divided into 2 groups: with detected restenosis or neointima (n=49) and without restenosis (n=43). The clinical, laboratory, and angiographic data obtained in the groups were compared.

Results. The development of restenosis is associated with a prolonged course of CAD — 6.0 (4.0; 11.0) months (p<0.001), stable CAD was recorded in 42.86% (p=0.01), chronic kidney disease (CKD) 3A 32.65% (p=0.02) and the use of bare-metal stent (BMS) was 79.59% (n=39) (p<0.001), Lp(a) level >30 mg/dL 36.73% (p=0.01). Analysis of combinations revealed that having both TGF-β and Lp(a) within normal ranges simultaneously was a protective factor against restenosis development (odds ratio=0.2 [95% confidential interval: 0.07-0.56]), as was having both Lp(a) and VEGF within normal ranges (odds ratio=0.33 [95% confidential interval: 0.14-0.82]). 

Conclusion. In CAD patients 1-2 months post-PCI for ACS, restenosis development is associated with longer CAD duration, CKD stage 3A, use of BMS, and elevated Lp(a) levels >30 mg/dL, irrespective of achieving the target LDL-C level <1.4 mmol/L. Elevated baseline Lp(a) values combined with VEGF and TGF-β levels in blood plasma indicates a high risk of stent restenosis, which may be new biomarkers for predicting the progression of coronary artery disease. These results confirm the need to develop practical guidelines for the dynamic monitoring of this patient group.

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