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

BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD)develop recurrent angina pectoris following successful and complete coronary revascularization utilizingpercutaneous coronary intervention (PCI). We aim to investigate predictors of recurrent angina pectorisin patients who have undergone successful coronary revascularization using PCI, but on repeat coronaryangiography have no need for secondary revascularization.METHODS: The study comprised 3,837 patients with CAD, who were enrolled from January2007 to June 2019. They had undergone successful PCI;some of them redeveloped anginapectoris within one year after the procedure, but on repeat coronary angiography had no need forrevascularization. Thrombolysis in myocardial infarction (TIMI) frame count was used to evaluatethe velocity of coronary blood in the follow-up angiogram. Multivariate logistic regression was usedto investigate risk factors for recurrent angina pectoris. Similarly, predictors of recurrent anginaaccording 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 riskfactors for recurrent angina pectoris: female sex, older age, current smoking, low-density lipoproteincholesterol (LDL-C) ≥1.8 mmol/L, and an elevated TIMI frame count (P for all <0.05). Similarly, usingmultivariate 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 dualantiplatelet therapy.CONCLUSIONS: Patient characteristics of female sex, older age, diabetes, and elevated BMIare associated with an increased TIMI frame count, coronary microcirculation dysfunction, and recurrentangina pectoris after initially successful PCI. In addition, current smoking and LDL-C ≥1.8 mmol/L arerisk factors for recurrent angina pectoris. In contrast, the treatment with dual antiplatelet therapy isnegatively correlated with a higher TIMI frame count and the risk of recurrent angina pectoris.

Predictive factors of recurrent angina after acute coronary syndrome： the global registry acute coronary events from China （Sino-GRACE）

Background Many patients with acute coronary syndrome （ACS） develop recurrent angina （RA） during hospitalization. The aim of this non-randomized, prospective study was to investigate the predictive factors of RA in unselected patients with ACS enrolled in the global registry acute coronary events （GRACE） during hospitalization in China.Methods Between March 2001 and October 2004., enrolled were 1433 patients with ACS, including ST segment elevation myocardial infarction （662, 46.2%）, non-ST segment elevation myocardial infarction （239, 16.7%） and unstable angina （532, 37.1%）. The demographic distribution, medical history and clinical data were collected to investigate the predictive factors of RA by Logistic regression. Results During hospitalization 275 （19.2%） patients were documented with RA including unstable angina （53.2%）, non- ST segment elevation myocardial infarction （27.5%）, ST segment elevation myocardial infarction （19.3%）. A comorbidity of dyslipidemia, prior angina, percutaneous coronary intervention （PCI） within 6 months was more common in patients with RA, P〈0.05. In the patients with RA, a significantly higher proportion of patients with acute pulmonary edema was observed, 23 （8.4%） versus 43 （3.7%）, P=0.001. Acute renal failure was present in 8 （2.9%） of patients with RA versus 19 （1.6%） of patients without RA, P=0.165. Hemorrhagic events were present in 6 （2.2%） of patients with RA versus 8 （0.7%） of patients without RA, ventricular tachycardia/ventricular fibrillation events in 12 patients （4.3%） versus 22 patients （1.9%）, congestive heart failure in 69 patients （25.0%） versus 94 patients （8.1%）, myocardial re-infarction in 28 patients （10.1%） versus 15 patients （1.3%）, P〈0.05, respectively. A lower proportion of patients with RA underwent in-hospital PCI 687 （59.3%） versus 114 （41.5%）, P=0.000. A higher proportion of patients with RA received heparin, 260 （94.5%） versus 1035 （89.4%）, P=0.006; and beta-blockers 176（64.0%） versus 864 （74.5%）, P=-0.000. Multivarible regression analysis showed that RA was associated with prior angina （OR 2.086, 95% Cl 1.466-2.967）, in-hospital PCI （OR 0.579, 95% Cl 0.431-0.778）, in-hospital congestive heart failure （OR 2.410, 95% Cl 1.634-3.555）, myocardial re-infarction （OR 7.695, 95%C/3.701-15.999）, beta-blocker （OR 0.626, 95%C/0.458-0.855）, and heparin （OR 3.411,95%C/1.604-7.382）. Conclusions In-hospital congestive heart failure, myocardial re-infarction, prior angina history and use of heparin are stronaer independent predictors of RA; beta-blockers and PCI are also important predictive factors for RA.