Predictors of recurrent angina in patients with no need for secondary revascularization

doi:10.5847/wjem.j.1920-8642.2021.01.007

Abstract

Abstract:

BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD) develop recurrent angina pectoris following successful and complete coronary revascularization utilizing percutaneous coronary intervention (PCI). We aim to investigate predictors of recurrent angina pectoris in patients who have undergone successful coronary revascularization using PCI, but on repeat coronary angiography have no need for secondary revascularization.

METHODS: The study comprised 3,837 patients with CAD, who were enrolled from January 2007 to June 2019. They had undergone successful PCI; some of them redeveloped angina pectoris within one year after the procedure, but on repeat coronary angiography had no need for revascularization. Thrombolysis in myocardial infarction (TIMI) frame count was used to evaluate the velocity of coronary blood in the follow-up angiogram. Multivariate logistic regression was used to investigate risk factors for recurrent angina pectoris. Similarly, predictors of recurrent angina according to the TIMI frame count were assessed using multivariate linear regression.

RESULTS: In this retrospective study, 53.5% of patients experienced recurrent angina pectoris. By multivariate logistic regression, the following characteristics were statistically identified as risk factors for recurrent angina pectoris: female sex, older age, current smoking, low-density lipoprotein cholesterol (LDL-C) ≥1.8 mmol/L, and an elevated TIMI frame count (P for all <0.05). Similarly, using multivariate linear regression, the statistical risk factors for TIMI frame count included: female sex, older age, diabetes, body mass index (BMI), post-procedural treatment without the inclusion of dual antiplatelet therapy.

CONCLUSIONS: Patient characteristics of female sex, older age, diabetes, and elevated BMI are associated with an increased TIMI frame count, coronary microcirculation dysfunction, and recurrent angina pectoris after initially successful PCI. In addition, current smoking and LDL-C ≥1.8 mmol/L are risk factors for recurrent angina pectoris. In contrast, the treatment with dual antiplatelet therapy is negatively correlated with a higher TIMI frame count and the risk of recurrent angina pectoris.

Key words: Recurrent angina, Thrombolysis in myocardial infarction frame count, Predictors

Tian Xu, Ya Li, Li-ding Zhao, Guo-sheng Fu, Wen-bin Zhang. Predictors of recurrent angina in patients with no need for secondary revascularization[J]. World Journal of Emergency Medicine, 2021, 12(1): 42-47.

Figures/Tables 3

Table 1

Figure 1.

Table 2

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Variables	Univariate regression			Multivariate regression
Variables	OR	95% CI	P-value	OR	95% CI	P-value
Age	1.281	1.201-1.367	<0.001	1.313	1.221-1.412	<0.001
Female	1.150	0.996-1.328	0.057	1.236	1.044-1.464	0.014
BMI	1.011	0.990-1.033	0.299	1.018	0.995-1.041	0.135
Current smoking	1.015	0.875-1.177	0.842	1.210	1.026-1.428	0.024
Diabetes	0.894	0.767-1.040	0.147	0.865	0.738-1.014	0.073
Hypertension	1.243	1.087-1.422	0.002	1.120	0.967-1.297	0.130
CRP	1.008	0.998-1.018	0.112	1.004	0.993-1.015	0.472
PLT	0.999	0.998-1.000	0.079	0.999	0.998-1.000	0.125
LDL-C ≥1.8 mmol/L	1.172	1.024-1.341	0.022	1.194	1.036-1.376	0.015
SUA	1.001	1.000-1.001	0.115	1.000	1.000-1.001	0.414
Beta blocker	1.150	1.012-1.306	0.032	1.210	1.057-1.386	0.006
CCB	1.130	0.909-1.405	0.271	1.088	0.862-1.375	0.447
Dual antiplatelet	0.989	0.862-1.134	0.873	1.025	0.887-1.185	0.737
TIMI frame count	1.024	1.015-1.033	<0.001	1.026	1.017-1.036	<0.001
Multiple vessels PCI	0.890	0.731-1.085	0.250	0.867	0.697-1.079	0.202
Total stent length	1.000	0.997-1.002	0.730	1.000	0.997-1.003	0.951
Stent size >2.5 mm	1.103	0.888-1.370	0.377	1.181	0.939-1.486	0.154
EF	0.997	0.990-1.003	0.307	0.998	0.991-1.006	0.680

Variables	Simple regression			Multiple regression
Variables	β	95% CI	P-value	β	95% CI	P-value
Age	0.558	0.350-0.767	<0.001	0.317	0.074-0.560	0.011
Female	1.877	1.397-2.357	<0.001	1.651	1.079-2.223	<0.001
Body mass index	0.199	0.124-0.275	<0.001	0.155	0.077-0.233	<0.001
Current smoking	0.863	0.333-1.394	0.001	0.042	-0.522-0.607	0.884
Diabetes	0.722	0.272-1.295	0.010	0.717	0.178-1.256	0.009
Hypertension	-0.930	-1.412- -0.448	<0.001	-0.712	-1.215- -0.209	0.006
CRP	-0.007	-0.040-0.027	0.692	-0.013	-0.045-0.020	0.440
PLT	0.000	-0.004-0.004	0.928	0.001	-0.004-0.005	0.814
LDL-C ≥1.8 mmol/L	0.199	-0.286-0.684	0.420	0.017	-0.467-0.501	0.946
SUA	0.005	0.002-0.007	<0.001	0.001	-0.002-0.003	0.593
Beta blocker	0.389	-0.068-0.847	0.095	0.050	-0.526-0.627	0.864
CCB	-0.193	-0.971-0.585	0.626	0.096	-0.699-0.891	0.813
Dual antiplatelet	-0.427	-0.921-0.066	0.089	-0.537	-1.035- -0.040	0.034
Multiple vessels PCI	0.241	-0.470-0.951	0.506	0.104	-0.636-0.845	0.783
Total stent length	-0.005	-0.014-0.005	0.332	-0.002	-0.012-0.008	0.689
Stent size >2.5 mm	0.424	-0.357-1.204	0.287	0.281	-0.502-1.064	0.482
EF	0.003	-0.021-0.027	0.825	0.015	-0.009-0.040	0.216