PROGNOSTIC MARKERS OF RESTENOSIS IN PATIENTS WITH PERIPHERAL ARTERY DISEASE AFTER ENDOVASCULAR PROCEDURES

Abstract

Objective. To study the role of hemostatic parameters as potential markers of restenosis in patients with peripheral artery disease (PAD) after endovascular procedures. Methods. An open prospective study involved 55 PAD patients aged 63 (57; 69) with the stage IIb-IV Fontaine chronic lower limb ischemia; 48 (87.3%) subjects were male; 18 (32.73%) patients had type 2 diabetes mellitus (T2D). Before angioplasty or stenting of the arteries of the lower extremities, the activity of protein C (PrC), the levels of soluble endothelial receptors for protein C (sEPCR), the activity of coagulation factors FVIII, FIX, FXI were determined in the peripheral blood. Within a year every three months Duplex ultrasound or angiography for follow-up examination have been performed to detect restenosis. Results. Within one year restenosis was detected in 13 (23.6%) patients. Binary regression analysis revealed T2D, FVIII activity and sEPCR as prognostic markers of restenosis. sEPCR level lower than 46.8 ng/ml was associated with a 4.263 higher risk for restenosis after endovascular procedures (odds ratio 4.263, CI 95% 1.509-12.042); absolute risk 47±11% (CI 95% 25-69 %). The patients with T2D had a 2.6 higher risk for restenosis as compared to subjects without diabetes mellitus (odds ratio 2.6, CI 95% 1.031-6.599); absolute risk 41.18±12% (CI 95% 17.78-64.58%). The probability of developing restenosis was inversely related to the initial indicators of FVIII activity and the level of sEPCR: the lower the absolute values of FVIII and sEPCR, the higher the likelihood of developing restenosis in the postoperative period. Conclusion. Patientswith diabetes mellitus (type 2), reduced activity of coagulation factor FVIII and level of soluble endothelial protein C receptors are at particularlyhigh riskforrestenosis What this paper adds The study of hemostasis parameters in patients with the peripheral atherosclerosis revealed that the sEPCR level below 46.8 ng/ml corresponded to an elevateion of restenosis risk after endovascular interventions by 4.263 folds (odds ratio 4.263, 95% CI 1.509-12.042), the presence of type 2 diabetes mellitus - in 2.6 folds (odds ratio 2.6, 95% CI 1.031-6.599). The likelihood of developing restenosis was inversely related to baseline FVIII activity and sEPCR levels. The authors proposed a method for calculating the individual probability of developing restenosis using the abovementional indicators.