Clinical Predictors of the Rapid Progression and Revascularization of Coronary Non-Target Lesions: A Serial Angiographic Study

TL;DR

This study identifies clinical factors that predict rapid progression and revascularization of coronary non-target lesions, which can help prevent future cardiovascular events.

Contribution

The study provides new clinical predictors for rapid progression and revascularization of non-target coronary lesions.

Findings

Hypertension, STEMI, glycosylated hemoglobin, and lesion classification predict rapid lesion progression.

Triglyceride levels and lesion classification predict lesion revascularization.

Patients with these factors should receive increased attention to prevent cardiovascular events.

Abstract

Rapid progression of coronary non-target lesions is
essential for the determination of future cardiovascular events. Clinical factors
that predict rapid progression of non-target lesions are unclear. The purpose of this study was to identify the clinical
predictors of rapid progression and revascularization of coronary non-target
lesions.

Consecutive patients with coronary heart disease who
had undergone two serial coronary angiograms were enrolled. All coronary
non-target lesions were identified and evaluated at both procedures.
Multivariable Cox regression analysis was used to investigate the clinical risk
factors associated with rapid progression or revascularization of coronary
non-target lesions.

A total of 1255 patients and 1670 lesions
were enrolled. In this cohort of patients, 239 (19%) had rapid progression and
186 (14.8%) underwent revascularization. At the lesion level, 251 (15.0%) had
rapid progression and 194 (11.6%) underwent revascularization. The incidence of
lesion revascularization and myocardial infarction was significantly higher in
patients with rapid progression. In multivariable analyses, hypertension (hazard
ratio [HR], 0.76; 95% confidence interval [95% CI], 0.58–1.00; p =
0.049), ST-segment elevation myocardial infarction (STEMI) (HR, 1.46; 95% CI,
1.03–2.07; p = 0.035), glycosylated hemoglobin (HR, 1.16; 95% CI,
1.01–1.33; p = 0.039) and lesion classification (B2/C versus A/B1) (HR,
1.73; 95% CI, 1.27–2.35; p = 0.001) were significant factors
associated with rapid progression. The level of triglycerides (HR, 1.10; 95% CI,
1.00–1.20; p = 0.040) and lesion classification (B2/C versus A/B1) (HR,
1.53; 95% CI, 1.09–2.14; p = 0.014) were predictors of lesion
revascularization.

Hypertension, STEMI, glycosylated
hemoglobin and lesion classification may be used as predictors of rapid
progression of coronary non-target lesions. The level of triglyceride and lesion
classification may predict the revascularization of non-target lesions. In order
to prevent future cardiovascular events, increased attention should be paid to
patients with these factors.

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