Abstract

Patients with cardio-renal-metabolic (CRM) conditions are at high risk of cardiovascular mortality due to the combination of heart failure, chronic kidney disease (CKD), endocrine disorders, as well as a significant risk of ischemic heart disease and complications from systemic atherosclerosis. The presence of heart failure (HF) in these patients complicates prognosis and increases the likelihood of recurrent cardiovascular events. Objective: To study the risk of major cardiovascular events or the necessity for repeat coronary interventions after primary percutaneous coronary intervention in patients with CRM conditions based on the type of HF. Materials and Methods: The study included 126 patients who underwent percutaneous coronary intervention for coronary heart disease. The average age of the patients was 58.1±0.4 years, with 78 (61.9%) being male. CRM condition was defined as a combination of HF, stage ≥3 CKD, and type 2 diabetes mellitus. Patients were divided into 4 groups based on the presence of heart failure: clinical group 1 — patients with CRM conditions and HF with preserved left ventricular ejection fraction (HFpEF; n=34); clinical group 2 – patients with CRM conditions and HF with moderately reduced EF (HFmrEF) (n=31); clinical group 3 — patients with CRMS and heart failure with significantly reduced EF (HFrEF, n=31); comparison group 4 with type 2 diabetes, CKD, and no signs of HF (stage A) (n=30). A 5-year follow-up period from stent placement for each patient. Endpoint criteria included cardiovascular death, acute myocardial infarction, recurrent angina requiring repeat coronary intervention. Results: Patients with HFrEF had the highest percentage among patients who reached the endpoint during the 5-year observation period. The group of patients without HF showed the best results in interventional treatment. The most common cause of coronary artery disease recurrence was restenosis in previously placed coronary stents or the development of significant stenosis in new areas.

Conclusion: The presence of the heart failure phenotype with reduced left ventricular ejection fraction in CRM condition is associated with a worse prognosis for patients after percutaneous coronary intervention due to a higher incidence of coronary artery stenosis in new locations.

Key words: cardio-renal-metabolic syndrome, coronary artery disease, percutaneous coronary intervention, heart failure, restenosis

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