Angiographic profile and clinical outcome in repeat revascularization in patients with multivessel percutaneous coronary intervention:  A prospective cross-sectional study.

T. Dharmatheja; Lais Mohammad; Mathew Iype; Priya S

doi:10.51168/sjhrafrica.v7i2.2733

Autori

T. Dharmatheja Senior resident, Department of Cardiology, Government Medical College, Thiruvananthapuram, India
Lais Mohammad Department of Cardiology, Assistant Professor, Government Medical College, Thiruvananthapuram, India
Mathew Iype Professor & Head, Department of Cardiology, Government Medical College, Thiruvananthapuram, India
Priya S Department of Cardiology, Assistant Professor, Government Medical College, Thiruvananthapuram, India

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2733

Cuvinte cheie:

Multivessel PCI, repeat revascularization, in-stent restenosis, MACE, angiographic profile, drug-eluting stent

Rezumat

Background

Multivessel coronary artery disease treated with percutaneous coronary intervention (PCI) carries a significant risk of repeat revascularization due to in-stent restenosis or progression of coronary disease. Identifying angiographic predictors and clinical outcomes is essential for improving long-term management.

Objectives: To evaluate the angiographic profile and clinical outcomes of patients undergoing repeat revascularization following multivessel PCI.

Methods

This prospective observational study included 80 patients who underwent repeat revascularization after multivessel PCI at the Department of Cardiology, Government Medical College, Thiruvananthapuram, over 18 months. Angiographic characteristics, including target vessel, lesion morphology, stent type, and in-stent restenosis, were assessed. Clinical outcomes, including major adverse cardiovascular events (MACE), mortality, myocardial infarction, and target vessel revascularization, were recorded over 6 months.

Results

The mean age was 58.4 ± 9.7 years, and 76.3% of participants were male. The left anterior descending artery was the most commonly involved vessel (52.5%), while in-stent restenosis was the predominant mechanism of repeat revascularization (57.5%). Drug-eluting stents were used in 92.5% of patients. At 6 months, MACE occurred in 17.5% of patients. Diabetes mellitus (p=0.012) and diffuse in-stent restenosis (p=0.028) were independent predictors of adverse outcomes.

Conclusion

Repeat revascularization after multivessel PCI remains associated with substantial cardiovascular risk, particularly among patients with diabetes mellitus and diffuse in-stent restenosis.

Recommendations

High-risk patients should receive close follow-up, aggressive risk-factor control, and optimized secondary prevention. Larger multicenter studies with longer follow-up are needed to validate these findings.

Biografii autori

T. Dharmatheja, Senior resident, Department of Cardiology, Government Medical College, Thiruvananthapuram, India

is a Senior Resident in the Department of Cardiology at Government Medical College, Thiruvananthapuram, with research interests in interventional cardiology and coronary artery disease.
Lais Mohammad, Department of Cardiology, Assistant Professor, Government Medical College, Thiruvananthapuram, India

is an Assistant Professor in the Department of Cardiology with interests in cardiovascular imaging and coronary interventions.
Mathew Iype, Professor & Head, Department of Cardiology, Government Medical College, Thiruvananthapuram, India

is Professor and Head of the Department of Cardiology with extensive experience in interventional cardiology and cardiovascular research.
Priya S, Department of Cardiology, Assistant Professor, Government Medical College, Thiruvananthapuram, India

is an Assistant Professor in the Department of Cardiology whose research focuses on coronary artery disease and clinical cardiology.

Referințe

World Health Organization. Global Health Estimates: Leading Causes of Death. WHO; 2020.

Park DW, Clare RM, Schulte PJ, et al. Extent, location, and clinical significance of non-infarct-related coronary artery disease among patients with ST-elevation myocardial infarction. JAMA. 2014;312(19):2019–2027.

Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87–165.

Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360(10):961–972.

Bangalore S, Toklu B, Amoroso N, et al. Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis. BMJ. 2013;347:f6625.

Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet. 2018;391(10124):939–948.

Alfonso F, Byrne RA, Rivero F, Kastrati A. Current treatment of in-stent restenosis. J Am Coll Cardiol. 2014;63(24):2659–2673.

Cassese S, Byrne RA, Tada T, et al. Incidence and predictors of restenosis after coronary stenting in 10,004 patients with surveillance angiography. Heart. 2014;100(2):153–159.

Kanaya AM, Grady D, Barrett-Connor E. Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus. Arch Intern Med. 2002;162(15):1737–1745.

Gupta R, Mohan I, Narula J. Trends in coronary heart disease epidemiology in India. Ann Glob Health. 2016;82(2):307–315.

Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503–1516.

De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367(11):991–1001.

Hannan EL, Racz M, Holmes DR, et al. Impact of completeness of percutaneous coronary intervention revascularization on long-term outcomes in the stent era. Circulation. 2006;113(20):2406–2412.

Mehran R, Dangas G, Abizaid AS, et al. Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation. 1999;100(18):1872–1878.

Vijayvergiya R, Jain A, Sharma V, Kumar A. Outcomes of repeat revascularization in multivessel CAD: an Indian tertiary care experience. Indian Heart J. 2020;72(4):280–286.

Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions. Circulation. 2016;133(16):1605–1620.

Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet. 2012;380(9841):601–610.

Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293(17):2126–2130.

Mehran R, Baber U, Steg PG, et al. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS). Lancet. 2013;382(9906):1714–1722.

Iniguez A, Fernandez-Ortiz A, Gonzalo N, et al. Clinical outcomes in patients with ISR: the DESERT registry. JACC Cardiovasc Interv. 2018;11(4):370–378.

Farooq V, Serruys PW, Garcia-Garcia HM, et al. The negative impact of incomplete angiographic revascularization on clinical outcomes and its association with total occlusions. Eur Heart J. 2013;34(22):1681–1691.

Alfonso F, Pérez-Vizcayno MJ, Cárdenas A, et al. A prospective randomized trial of drug-eluting balloons versus everolimus-eluting stents in patients with in-stent restenosis of drug-eluting stents (RIBS IV trial). J Am Coll Cardiol. 2015;66(1):23–33.

Pfeffer MA, Braunwald E, Moyé LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 1992;327(10):669–677.

Mehta SR, Wood DA, Storey RF, et al. Complete revascularization with multivessel PCI for myocardial infarction. N Engl J Med. 2019;381(15):1411–1421.

Mintz GS, Guagliumi G. Intravascular imaging in coronary artery disease. Lancet. 2017;390(10096):793–809.