Management of the risk of coronary and peripheral revascularization within 3 years after coronary angiography in patients with coronary artery disease

Aim. To develop an approach to reduce the frequency of urgent coronary and peripheral revascularization by influencing modifiable risk factors.

Material and methods. A cohort of patients with coronary artery disease (n=218; 63±10,9 years, 54% men) who underwent coronary angiography (CAG), including stenting. A number of routine anthropometric and biochemical parameters were analyzed in all patients. Statistical analysis was performed using Statistica version 8.0 and SPSS IBM statistics 23 software using ROC analysis, binomial logistic regression, 2´2 contingency tables and Pearson c2 for hypothesis testing.

Results. A combination of noninvasive parameters associated with the maximum relative risk (RR) of coronary and peripheral artery revascularization over the 3 years after CAG was identified (RR=15 (95% confidence interval (CI): 5,96-36,5, p=0,001), compared with other possible combinations of the studied parameters. This combination included waist circumference with a limit of 89 cm, smoking status, and four following biochemical markers: C-reactive protein with a limit of 3,4 mg/l, glucose with a limit of 7,6 mmol/l, insulin with a limit of 10 μU/ml, and low-density lipoprotein cholesterol with a limit of 2,9 mmol/l.

Conclusion. A scale-table of the relative risk (RR) of coronary and peripheral revascularization over the 3 years after elective diagnostic CAG. The scale-table demonstrates the possibility of managing the risk of coronary and peripheral revascularization after CAG and motivating the patient to modify risk factors.

1. Boytsov SA, Shalnova SA, Deev AD. Cardiovascular mortality in the Russian Federation and possible mechanisms of its exchanges. S. S. Korsakov Journal of Neurology and Psychiatry. 2018;118(8):98-103. (In Russ.) doi:10.17116/jnevro201811808198.

2. Tadayon S, Wickramasinghe K, Townsend N. Examining trends in cardiovascular disease mortality across Europe: how does the in-troduction of a new European Standard Population affect the description of the relative burden of cardiovascular disease? Popul Health Metr. 2019;17(1):6. doi:10.1186/s12963-019-0187-7.

3. Ermolao A, Gasperetti A, Rigon A, et al. Comparison of cardiovascular screening guidelines for middle-aged/older adults. Scand J Med Sci Sports. 2019;9:1375-82. doi:10.1111/sms.13457.

4. Bockeria LA, Alekyan BG. Endovascular diagnostics and treat¬ment of cardiovascular diseases in the Russian Federation (2015). Endovaskulyarnaya hirurgiya. 2016;3(2):5-21. (In Russ.)

5. Stone GW, Maehara A, Lansky AJ, et al. A prospective natural history study of coronary atherosclerosis. N Engl J Med. 2011; 364:226-35. doi:10.1056/NEJMoa1002358.

6. Marzilli M, Merz CN, Boden WE, et al. Obstructive coronary atherosclerosis and ischemic heart disease: an elusive link. J Am Coll Cardiol. 2012;60(11):951-6. doi:10.1016/j.jacc.2012.02.082.

7. Montalescot G, Sechtem U, Achenbach S, et al.; ESC Committee for Practice Guidelines; Zamorano JL, Achenbach S, Baumgartner H, et al.; Document Reviewers; Knuuti J, Valgimigli M, Bueno H, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003.

8. Gumanova NG, Gavrilova NE, Сernushevich OI, et al. Ratios of leptin to insulin and adiponectin to endothelin are sex-dependently associated with extent of coronary atherosclerosis. Biomarkers. 2017;3-4:239-45. doi:10.1080/1354750X.2016.1201539.

9. Gumanova NG, Vasilyev DK, Bogdanova NL, Drapkina OM. Serum Level of Cadherin-¬P (CDH3) Is a Novel Predictor of Cardiovascular Events Related to Atherosclerosis in a 3-Year Follow-Up Study. J Clin Med. 2024;13(21):6293. doi:10.3390/jcm13216293.

10. Peterson BE, Bhatt DL, Ballantyne CM, et al. Inadequate Intensification of LDL-cholesterol lowering therapy after coronary revascularization: Insights from the GOULD registry. Int J Cardiol. 2025;421:132916. doi:10.1016/j.ijcard.2024.132916.

11. Stone NJ, Robinson JG, Lichtenstein AH, et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25)(suppl 2):S1-45.

12. Collins R, Reith C, Emberson J, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016; 388(10059):2532-61. doi:10.1016/S0140-6736(16)31357-5.

13. Barter PJ. High- Versus Low-Dose Statin: Effects on Cardiovascular Events and All-Cause Death. Circulation. 2018;137(19): 2013-5. doi:10.1161/CIRCULATIONAHA.118.034407.

14. Schade DS, Shey L, Eaton RP. Cholesterol Review: A Metabolically Important Molecule. Endocr Pract. 2020;26(12):1514-23. doi:10.4158/EP-2020-0347.

15. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi:10.1093/eurheartj/ehx393.

16. Pinheiro de Melo EM, Lopes Ferreira P. Quality of life 2 years after coronary revascularization. Enferm Clin. 2007;17(6):309-17. doi:10.1016/s1130-8621(07)71823-5.