A Review of the Association Between Demographic, Laboratory, and Angiographic Findings and Major Cardiovascular Events in Patients Undergoing Elective Percutaneous Coronary Interventions

Document Type : Original Article


Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.


Background: Coronary artery disease is the leading cause of mortality worldwide. With the increasing number of elderly people and the development of stents, the tendency to perform percutaneous procedures has increased, leading to an increased risk of complications known as major adverse cardiovascular events (MACE). This study aimed to assess the association between demographic, laboratory, and angiographic findings and MACE in patients undergoing elective angiography.
Methods: This cross-sectional descriptive study enrolled 300 patients older than 18 scheduled for elective angiography in Rajaie Cardiovascular Medical and Research Center between 2015 and 2016. Those who did not undergo stenting or needed surgery initially were excluded, leaving 207 patients. The demographic, laboratory, and angiographic data of these patients were collected, and they were then followed for 2 years.
Results:During a mean follow-up of 24 months, MACE occurred in 20 (9.60%) patients, with 1 patient experiencing 2 events. There was significant relationships between older age (p = 0.01), the female gender (p < 0.0001), the body mass index (P < 0.0001), total cholesterol (p = 0.01), low-density lipoprotein (P = 0.001), high-density lipoprotein (p = 0.003), triglycerides (p = 0.014), hemoglobin (P = 0.004), lower glomerular filtration rates (p < 0.0001), higher post-angiography troponin I (p < 0.0001), and fasting blood sugar (p < 0.0001) and MACE. There were also relationships between the incidence of cardiovascular diseases and the number of diseased vessels (p = 0.047) and between the need for repeated revascularization and the number of vessels (p = 0.01).
Conclusions: As many MACE risk factors are modifiable, we suggest that patients with the aforementioned risk factors be monitored more closely after percutaneous coronary interventions to predict and prevent the incidence of MACE. (Iranian Heart Journal 2020; 21(4): 93-102)






Hatmi ZN, Tahvildari S, Gafarzadeh Motlag A, Sabouri Kashani A. Prevalence of coronary artery disease risk factors in Iran: a population based survey. BMC Cardiovasc Disord. 2007;7:32-.
Weinstein MC, Coxson PG, Williams LW, Pass TM, Stason WB, Goldman L. Forecasting coronary heart disease incidence, mortality, and cost: the Coronary Heart Disease Policy Model. Am J Public Health. 1987;77(11):1417-26.
Delahaye F, Roth O, de Gevigney G. [Epidemiology of acute coronary syndrome]. Rev Prat. 2003;53(6):607-10.
Koch CG, Weng YS, Zhou SX, Savino JS, Mathew JP, Hsu PH, et al. Prevalence of risk factors, and not gender per se, determines short- and long-term survival after coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2003;17(5):585-93.
Poudel I, Tejpal C, Rashid H, Jahan N. Major Adverse Cardiovascular Events: An Inevitable Outcome of ST-elevation myocardial infarction? A Literature Review. Cureus. 2019;11(7):e5280-e.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-52.
Choi A-R, Jeong MH, Hong YJ, Sohn S-J, Kook HY, Sim DS, et al. Clinical characteristics and outcomes in acute myocardial infarction patients with versus without any cardiovascular risk factors. Korean J Intern Med. 2019;34(5):1040-9.
Shah B, Baber U, Pocock SJ, Krucoff MW, Ariti C, Gibson CM, et al. White Blood Cell Count and Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention in the Contemporary Era: Insights From the PARIS Study (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Registry). Circ Cardiovasc Interv. 2017;10(9).
Edes IF, Ruzsa Z, Szabo G, Nardai S, Becker D, Benke K, et al. Clinical predictors of mortality following rotational atherectomy and stent implantation in high-risk patients: A single center experience. Catheter Cardiovasc Interv. 2015;86(4):634-41.
Wang X, Qiu M, Li J, Wang H, Qi J, Wang G, et al. Impacts of anemia on 3-year ischemic events in patients undergoing percutaneous coronary intervention: a propensity-matched study. J Thorac Dis. 2015;7(11):1951-9.
Pan HC, Sheu WH, Lee WJ, Lee WL, Liao YC, Wang KY, et al. Coronary severity score and C-reactive protein predict major adverse cardiovascular events in patients with stable coronary artery disease (from the Taichung CAD study). Clin Chim Acta. 2015;445:93-100.
Tsai IT, Wang C-P, Lu Y-C, Hung W-C, Wu C-C, Lu L-F, et al. The burden of major adverse cardiac events in patients with coronary artery disease. BMC Cardiovasc Disord. 2017;17(1):1-.
Boudou N, Roncalli J, Lhermusier T, Moudens G, Celse D, Fourcade J, et al. Long-term clinical outcome after percutaneous coronary interventions in the elderly: results for 512 consecutive patients. EuroIntervention. 2008;3(4):512-7.
N O, B SK, M AP, M RK, B GY, H O. The correlation of diastolic dysfunction with TIMI frame count in patients with chronic stable angina pectoris. Tehran-Univ-Med-J. 2012;70(9):555-63.
Fath-Ordoubadi F, Spaepen E, El-Omar M, Fraser DG, Khan MA, Neyses L, et al. Outcomes in patients with acute and stable coronary syndromes; insights from the prospective NOBORI-2 study. PLoS One. 2014;9(2):e88577.
Gulati M, Cooper-DeHoff RM, McClure C, Johnson BD, Shaw LJ, Handberg EM, et al. Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women's Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med. 2009;169(9):843-50.
Aghajani H, Nezami P, Shafiee A, Jalali A, Nezami A, Nozari Y, et al. Predictors of Long-term Major Adverse Cardiac Events Following Percutaneous Coronary Intervention in the Elderly. Arch Iran Med. 2018;21(8):344-8.
Nakazato R, Arsanjani R, Achenbach S, Gransar H, Cheng VY, Dunning A, et al. Age-related risk of major adverse cardiac event risk and coronary artery disease extent and severity by coronary CT angiography: results from 15 187 patients from the International Multisite CONFIRM Study. Eur Heart J Cardiovasc Imaging. 2014;15(5):586-94.
Xu L, Yu C, Jiang J, Zheng H, Yao S, Pei L, et al. Major adverse cardiac events in elderly patients with coronary artery disease undergoing noncardiac surgery: A multicenter prospective study in China. Arch Gerontol Geriatr. 2015;61(3):503-9.
Guo Y, Yin F, Fan C, Wang Z. Gender difference in clinical outcomes of the patients with coronary artery disease after percutaneous coronary intervention: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(30):e11644-e.
Choi D, Choi S, Son JS, Oh SW, Park SM. Impact of Discrepancies in General and Abdominal Obesity on Major Adverse Cardiac Events. J Am Heart Assoc. 2019;8(18):e013471.
Su X, Kong Y, Peng D. Evidence for changing lipid management strategy to focus on non-high density lipoprotein cholesterol. Lipids Health Dis. 2019;18(1):134-.
Hosseini SK, Ansari MJ, Lotfi Tokaldany M, Sharafi A, Hakki Kazazi E, Poorhosseini H. Association between preprocedural hemoglobin level and 1-year outcome of elective percutaneous coronary intervention. J Cardiovasc Med (Hagerstown). 2014;15(4):331-5.
Jiang L, Gao Z, Song Y, Xu J, Tang X, Wang H, et al. Impact of anemia on percutaneous coronary intervention in Chinese patients: A large single center data. J Interv Cardiol. 2018;31(6):826-33.
Currie CJ, Berni ER, Berni TR, Jenkins-Jones S, Sinsakul M, Jermutus L, et al. Major adverse cardiovascular events in people with chronic kidney disease in relation to disease severity and diabetes status. PLoS One. 2019;14(8):e0221044.
Huang H, Zeng C, Ma Y, Chen Y, Chen C, Liu C, et al. Effects of Long-Term Statin Therapy in Coronary Artery Disease Patients with or without Chronic Kidney Disease. Dis Markers. 2015;2015:252564-.
Grandjean-Thomsen NL, Marley P, Shadbolt B, Farshid A. Impact of Mild-to-Moderate Chronic Kidney Disease on One Year Outcomes after Percutaneous Coronary Intervention. Nephron. 2017;137(1):23-8.
Sarnak MJ, Amann K, Bangalore S, Cavalcante JL, Charytan DM, Craig JC, et al. Chronic Kidney Disease and Coronary Artery Disease. JACC State-of-the-Art Review. 2019;74(14):1823-38.
Nageh T, Sherwood RA, Harris BM, Thomas MR. Prognostic role of cardiac troponin I after percutaneous coronary intervention in stable coronary disease. Heart. 2005;91(9):1181-5.
Leutner M, Tscharre M, Farhan S, Taghizadeh Waghefi H, Harreiter J, Vogel B, et al. A Sex-Specific Analysis of the Predictive Value of Troponin I and T in Patients With and Without Diabetes Mellitus After Successful Coronary Intervention. Front Endocrinol (Lausanne). 2019;10:105-.
Park DW, Flaherty JD, Davidson CJ, Yun SC, Lee SW, Kim YH, et al. Prognostic influence of diabetes mellitus on long-term clinical outcomes and stent thrombosis after drug-eluting stent implantation in asian patients. Am J Cardiol. 2009;103(5):646-52.
Lee MS, Jurewitz D, Zimmer R, Pessegueiro A, Bhatia R, Currier J, et al. Impact of diabetes and acute coronary syndrome on survival in patients treated with drug-eluting stents. Catheter Cardiovasc Interv. 2008;72(7):909-14.
Torresani E, Weisshein N, Martino G, Hrabar A, Fernández A, Cohen M, et al. Predictors of PTCA Failures in Q Wave AMI. Uni and Multivariate Analysis. 2019.
Redfors B, Chen S, Ben-Yehuda O, Huang X, Witzenbichler B, Weisz G, et al. Association Between Hypertension, Platelet Reactivity, and the Risk of Adverse Events After Percutaneous Coronary Intervention (From the ADAPT-DES Study). Am J Cardiol. 2019;124(9):1380-8.
Poli KA, Tofler GH, Larson MG, Evans JC, Sutherland PA, Lipinska I, et al. Association of blood pressure with fibrinolytic potential in the Framingham offspring population. Circulation. 2000;101(3):264-9.
Alidoosti M, Salarifar M, Zeinali AMH, Kassaian SE, Dehkordi MR. Comparison of outcomes of percutaneous coronary intervention on proximal versus non-proximal left anterior descending coronary artery, proximal left circumflex, and proximal right coronary artery: a cross-sectional study. BMC Cardiovasc Disord. 2007;7:7-.
Wang JC, Normand SL, Mauri L, Kuntz RE. Coronary artery spatial distribution of acute myocardial infarction occlusions. Circulation. 2004;110(3):278-84.
Campos CM, Costa F, Garcia-Garcia HM, Bourantas C, Suwannasom P, Valgimigli M, et al. Anatomic Characteristics and Clinical Implications of Angiographic Coronary Thrombus. Circulation: Cardiovascular Interventions. 2015;8(4):e002279.
Roguin A, Camenzind E, Kerner A, Beyar R, Boersma E, Mauri L, et al. Long-Term Outcomes of Stenting the Proximal Left Anterior Descending Artery in the PROTECT Trial. JACC Cardiovasc Interv. 2017;10(6):548-56.