Impact of the number of modifiable risk factors on clinical outcomes after percutaneous coronary intervention: An analysis from the e-Ultimaster registry.

Kobo, Ofer; Levi, Yaniv; Abu-Fanne, Rami; Von Birgelen, Clemens; Guédès, Antoine; Aminian, Adel; Laanmets, Peep; Dewilde, Willem; Witkowski, Adam; Monsegu, Jacques; Romo Iniguez, Andres; Halabi, Majdi; Mamas, Mamas A; Roguin, Ariel

Abstract

A substantial proportion of the patients undergoing percutaneous coronary intervention (PCI) have none of the of standard modifiable cardiovascular risk factors (SMuRFs): hypertension, diabetes, hypercholesterolaemia and smoking. The aim of this analysis was to compare clinical outcomes after PCI according to the number of SMuRFs. Patients with an indication for a PCI were stratified based upon the number of SMuRFs: 0, 1, 2 or 3-4. The primary outcome was target lesion failure (TLF), a composite of cardiac death, target vessel-related myocardial infarction or clinically driven target lesion revascularization at 1-year. Inverse weighted propensity score (IWPS) adjustment was performed to adjust for differences in baseline characteristics. The prevalence of SMuRFs was: 0 SMuRF 16.4 %; 1 SMuRF 27.8 %; 2 SMuRFs 34.7 % and 3-4 SMuRFs 21.1 %. Patients without SMuRFs were younger, more likely to be male and had less complex coronary artery disease. The incidence of TLF increased with the number of SMuRFs: 2.65 %, 2.75 %, 3.23 %, and 4.24 %, P  < 0.001. The relative risk (RR) for a TLF was 60 % higher (95 % confidence interval 1.32-1.93, p < 0.01) for patients with 3-4 SMuRFs compared to patients without SMuRFs. The trend remained (P  < 0.01) after IWPS with TLF rates of 2.88 %, 2.64 %, 2.88 % and 3.65 %. The RR for a TLF was 27 % higher (95 % CI 1.05-1.53, p < 0.01). The incidence of clinical events at 1-year increased with the number of SMuRFs. While patients without SMuRFs have a relatively favourable risk profile, more research is needed to optimize therapeutic management in the majority of patients. [Abstract copyright: © 2024 The Author(s).]

Citation

Kobo, O., Levi, Y., Abu-Fanne, R., Von Birgelen, C., Guédès, A., Aminian, A., …Roguin, A. (in press). Impact of the number of modifiable risk factors on clinical outcomes after percutaneous coronary intervention: An analysis from the e-Ultimaster registry. IJC Heart & Vasculature, 51, Article 101370. https://doi.org/10.1016/j.ijcha.2024.101370

• Journal Article Type: Article
• Acceptance Date: Feb 19, 2024
• Online Publication Date: Feb 26, 2024
• Deposit Date: May 8, 2024
• Journal: International journal of cardiology. Heart & vasculature
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 51
• Article Number: 101370
• DOI: https://doi.org/10.1016/j.ijcha.2024.101370
• Keywords: Clinical trial, Percutaneous coronary intervention, Human, Risk factor, Drug eluting stent
• Public URL: https://keele-repository.worktribe.com/output/823730