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Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis.

ABSTRACT: BACKGROUND:There have been limited data on the impact of hyperuricemia on long-term clinical outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR). METHODS:From January 2009 to July 2015, 317 patients who underwent repeat PCI for ISR were divided into two groups: patients with normal serum uric acid (UA) levels (normal UA group) and patients with higher serum UA levels (higher UA group). The higher UA group included patients with serum UA levels >?6.8 mg/dL or patients who were taking anti-hyperuricemic medication. RESULTS:During a median follow-up period of 1088 days, the cumulative incidence rates of major adverse event (MAE), including a composite of all-cause death, non-fatal myocardial infarction, and any revascularization, were similar between the two groups (higher UA 36.4% vs. normal UA 29.9%, p =?0.389, log-rank p =?0.367). Follow-up angiographic data showed similar outcomes of late lumen loss (0.8?±?0.9 mm vs. 0.8?±?1.1 mm, p =?0.895) and binary restenosis rate (28.1% vs. 34.7%, p =?0.622). Multivariate Cox regression analysis indicated higher levels of low-density lipoprotein cholesterol (hazard ratio [HR] 1.011, 95% confidence interval [CI] 1.003-1.019, p =?0.006) and lower left ventricular ejection fraction (HR 0.972, 95% CI 0.948-0.996, p =?0.022), but not UA levels, to be the independent risk predictors of MAE. CONCLUSION:Hyperuricemia is not associated with poor clinical outcomes after repeat PCI for ISR lesions.

SUBMITTER: Joo HJ

PROVIDER: S-EPMC5996510 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis.

Joo Hyung Joon HJ Jeong Han Saem HS Kook Hyungdon H Lee Seung Hun SH Park Jae Hyoung JH Hong Soon Jun SJ Yu Cheol Woong CW Lim Do-Sum DS

BMC cardiovascular disorders 20180611 1

<h4>Background</h4>There have been limited data on the impact of hyperuricemia on long-term clinical outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR).<h4>Methods</h4>From January 2009 to July 2015, 317 patients who underwent repeat PCI for ISR were divided into two groups: patients with normal serum uric acid (UA) levels (normal UA group) and patients with higher serum UA levels (higher UA group). The higher UA group included patients with serum UA levels > 6 ...[more]

PMID: 29890945

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Project description:In-stent restenosis (ISR) is the most common complication associated with percutaneous coronary intervention (PCI). Although some studies have reported an association between lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) and ISR, not enough clinical validation data are available to support this link. Here, we report our cross-sectional study aimed at exploring the feasibility of LOX-1 as a biomarker for the prognostic diagnosis of patients undergoing PCI.Three groups were included: ISR group, including 99 patients with ISR diagnosed with coronary arteriography (CAG) after PCI; lesion group, comprising 87 patients with coronary artery stenosis (<50%) diagnosed with CAG after PCI; and control group, consisting of 96 volunteers with no coronary artery disease. The levels of LOX-1 were measured in each patient by using an enzyme-linked immunosorbent assay, and their general information as well as laboratory parameters were recorded and followed up during a period of 2 years.LOX-1 levels gradually increased after PCI along with the progression of the lesion in the 3 groups. The levels of LOX-1 were significantly higher in the ISR group than in the other 2 groups (P?<?.001). LOX-1 levels were correlated with the levels of uric acid (UA) (r?=?0.289, P?=?.007), creatinine (CREA) (r?=?.316, P?=?.003), and high-density lipoprotein cholesterol (HDL-C) (r?=?-0.271, P?=?.012), whereas no statistically significant correlation was detected with the Gensini score (r?=?0.157, P?=?.141). The sensitivity and specificity of LOX-1 were 81.5% and 55.7%, respectively, with the most optimal threshold (5.04??g/L). The area under curve (AUC) of the receiver operator characteristic (ROC) curve of LOX-1 was 0.720, and LOX-1 had the highest AUC compared with CREA, UA, and HDL-C, both individually and in combination.A high level of LOX-1 in the early period after PCI has a certain predictive power and diagnostic value for ISR. However, the level of LOX-1 is not related to the Gensini score of coronary artery after PCI, and CREA and UA, which are weakly related to LOX-1, have no obvious synergy in the diagnosis of ISR with LOX-1.

Project description:BackgroundThis study aimed to develop and validate a nomogram to predict probability of in-stent restenosis (ISR) in patients undergoing percutaneous coronary intervention (PCI).MethodsPatients undergoing PCI with drug-eluting stents between July 2009 and August 2011 were retrieved from a cohort study in a high-volume PCI center, and further randomly assigned to training and validation sets. The least absolute shrinkage and selection operator (LASSO) regression model was used to screen out significant features for construction of nomogram. Multivariable logistic regression analysis was applied to build a nomogram-based predicting model incorporating the variables selected in the LASSO regression model. The area under the curve (AUC) of the receiver operating characteristics (ROC), calibration plot and decision curve analysis (DCA) were performed to estimate the discrimination, calibration and utility of the nomogram model respectively.ResultsA total of 463 patients with DES implantation were enrolled and randomized in the development and validation sets. The predication nomogram was constructed with five risk factors including prior PCI, hyperglycemia, stents in left anterior descending artery (LAD), stent type, and absence of clopidogrel, which proved reliable for quantifying risks of ISR for patients with stent implantation. The AUC of development and validation set were 0.706 and 0.662, respectively, indicating that the prediction model displayed moderate discrimination capacity to predict restenosis. The high quality of calibration plots in both datasets demonstrated strong concordance performance of the nomogram model. Moreover, DCA showed that the nomogram was clinically useful when intervention was decided at the possibility threshold of 9%, indicating good utility for clinical decision-making.ConclusionsThe individualized prediction nomogram incorporating 5 commonly clinical and angiographic characteristics for patients undergoing PCI can be conveniently used to facilitate early identification and improved screening of patients at higher risk of ISR.

Dataset Information

Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis.

Publications

Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis.

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