Am J Med Sci. 2021 May 20:S0002-9629(21)00182-8. doi: 10.1016/j.amjms.2021.05.012. Online ahead of print.
BACKGROUND: Elevated blood lipid level, also known as hyperlipoproteinemia (HLP), is the most common metabolic disorder in the general population. According to US National Heart Institute data, about 36% of adults and 10% of children aged 9 to 12 have elevated cholesterol levels. The risk of ischemic heart disease increases by 2-3% with every 1% increase in total cholesterol levels. Therefore, men aged 55-65 with a 10% increase in total cholesterol have about 38% increased ischemic heart disease mortality. The study's main objective is to determine the level of occurrence of thrombotic complications in patients in whom first-generation drug-eluting stents are implanted depending on the existence of HLP.
METHODS: The study is retrospective, clinical, non-interventionist, with a five-year follow-up period for each patient. Initially, 800 patients undergoing index percutaneous coronary angioplasty with sirolimus-eluting and paclitaxel-eluting stent implantation were enrolled. Clinical data of patients are data on cardiac disorders, the presence of diabetes mellitus, hyperlipoproteinemia, and smoking as a risk factor. In the examined group of patients, stent thrombosis was monitored according to ARC criteria.
RESULTS: Initially, the study included 800 patients who underwent percutaneous coronary angioplasty index. At the end of the follow-up period, the clinical trial was completed with 701 patients (87.6%), who underwent statistical analysis. Stent thrombosis, determined according to ARC criteria, was reported definitive stent thrombosis in 22 patients (3.06%). Probable stent thrombosis was reported in 1 patient (0.14%), possible stent thrombosis in 1 patient (0.14%). Of the 404 patients who had HLP, total cholesterol values over 300mg/dL were measured in 120 patients. Twenty patients with definitive stent thrombosis had cholesterol over 300mg/dL. Patients with probable and possible stent thrombosis did not have HLP. A comparison of patients with stent thrombosis, with HLP and without HLP, concluded a statistically significant difference (16.67% vs. 1.35%, p <0.001). Comparing patients with unstable angina pectoric, with HLP> 300 mg/dL and without HLP, a statistically significant difference was obtained (71.7% vs. 17.2%, p <0.001) CONCLUSIONS: The significance of our research is in the presentation of results with clinical therapeutic and prognostic significance and results with long-term follow-up of patients due to the current issue of stent thrombosis in drug-eluting stents. We can conclude that hyperlipoproteinemia influences the development of coronary disease, with a significant influence on complications following percutaneous coronary intervention.