title: Role of arterial stiffness and impaired renal function in the progression of new coronary lesions after percutaneous coronary intervention.
abstract: In the era of drug-eluting stents, revascularization of an initially non-target site owing to its progression as a new culprit lesion has emerged as a new therapeutic target of coronary artery disease. We aimed to clarify the prognostic factors for the progression of a previously non-significant coronary portion after prior percutaneous coronary intervention (PCI). We examined 275 patients who underwent PCI between February 2010 and January 2011 and had follow-up coronary angiography (CAG) after 6-12 months. Patients with target lesion revascularization were excluded. Finally, a total of 236 patients were included in this study. Thirty-three patients (14 %) underwent additional clinically driven PCI to treat previously non-significant lesions. There was no difference in background clinical characteristics between patients with and without additional PCI. The prevalence of chronic kidney disease (CKD; 61 vs. 31 %, p = 0.001) and multivessel disease (MVD; 55 vs. 35 %, p = 0.027), and the brachial-ankle pulse wave velocity (baPWV; 1,838 ± 371 vs. 1,589 ± 313 cm/s, p < 0.001) were significantly higher in patients with additional PCI than in those without. A multivariate analysis showed that CKD, MVD, higher baPWV, and lower high-density lipoprotein cholesterol at the follow-up CAG were independent determinants of the progression of new culprit coronary lesions. In conclusion, higher baPWV, CKD, and MVD are independent predictors of later additional PCI, suggesting an important role for arterial stiffness and impaired renal function in the progression of new culprit coronary artery lesions after PCI.
authors.affiliation: Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-ku, Tokyo, Japan. kanekohidehiro@gmail.com
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kaneko
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsuno
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Funada
authors.forename: Shingo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fukamachi
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D059289:Vascular Stiffness