Supervisors info:
Σιάσος Γεράσιμος, Αναπληρωτής Καθηγητής, Ιατρική,ΕΚΠΑ
Κυρίτση Ελένη, Καθηγήτρια, Νοσηλευτική, ΑΤΕΙ
Τούσουλης Δημήτριος, Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Introduction: Many risk factors are responsible for the onset of atherosclerosis, both modifiable and non-modifiable. Symptomatic coronary artery disease needs revascularization to reduce the complications due to it. However, rehospitalizations for acute coronary syndromes (ACS) or re-revascularization following acute myocardial infarction (CML) are very common. The aim of the present study is to highlight the effect of the aforementioned risk factors on a large number of coronary patients undergoing angioplasty and to indicate the extent to which each of them contributes to the appearance of restenosis following angioplasty.
Method: The study will introduce 300 coronary artery patients who underwent coronary angioplasty in the Hippocration Hospital of Athens aged 25 to 85 years. A record of age and other demographic characteristics, smoking habits (Fagerstrom scale), Med Diet Score, physical activity (IPAQ) as well as the rate of arterial hypertension, dyslipidemia, diabetes mellitus, obesity, sex, positive family history. In addition, the extent of coronary heart disease assessed. Patients after they left the hospital were prospectively monitored for 22 up to 37 months, and by telephone communication, any cardiovascular and non-cardiovascular events (including death) and resuscitation were recorded.
Results: A total of 365 patients with a recent angioplasty, either in acute coronary syndrome (ACS) or coronary angioplasty according to the indications, participated in the study, who were followed on an average 29,5 (22-37) months. One hundred and two patients (27.9%) (89% males) were rehomous for non-lethal ACS or recoronary due to symptomatology or indications (primary endpoint) who had a higher percentage of positive hereditary history of CAD (29.4% vs 19.8%, p =0.05). In an adjusted gender, age, and inheritance history model, HTN (1.88, p =0.05) and the presence of reperfusion stenosis in more than 2 vessels (1.71, p =0.05) were independent prognostic factors for reshaping. One hundred and twenty-eight patients (35%) experienced the secondary endpoint (new hospitalization due to ACS manifestation or new coronary angioplasty or other cardiovascular events (arrhythmias, pacemaker or defibrillator implantation, peripheral vascular disease, dehydration of heart failure) or hospitalization for major (81.1% vs. 71.1%, p = 0.05). In an adapted accounting model for gender, age, heart rate, and ≥2 vessel stenosis, HTN (OR = 2.37, p = 0.05) was shown to be a strong, independent predictor of new hospitalization due to the secondary endpoint. One hundred and thirty-seven patients [37.4%], 88.3% vs 87.3% males, p = 0.78) displayed the tertiary composite endpoint (hospitalizations for all causes: ACS manifestation or coronary angiography according to indications or for other cardiovascular events or major bleeding or other causes). HTN [OR = 1.90 (95% CI: 1.01-3.28), p = 0.02] and discontinuation of antiplatelet therapy [OR = 4.41 (95% CI: 1.09-17.93) independent prognostic factors with adaptation for confounding factors such as age and gender.
Conclusions: Arterial hypertension is a very important prognostic factor either for the emergence of a new ACS with or without the need for revascularization based on evidence or for the occurrence of another cardiovascular event or major bleeding.
