Influence of characteristics of vascular endothelial injury related factors on adverse clinical outcomes after intervention of second-generation drug-eluting stent in elderly patients with non-ST-segment elevation myocardial infarction

Yang Zhenyuan; Chen Yuxian; Yu Shujun

doi:10.3969/j.issn.1674-4055.2025.05.21

Abstract：Objective To investigate the influence of characteristics of vascular endothelial injury related factors on adverse clinical outcomes after intervention of second-generation drug-eluting stent(DES)in elderly patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods NSTEMI patients underwent second-generation DES were prospectively selected from the First Affiliated Hospital of Xinxiang Medical College from Jan.2023 to Feb.2024.The levels of peripheral intercellular adhesion molecule-1(ICAM1)and vascular adhesion molecule-1(VCAM1)were detected by using ELISA.The vascular endothelial function was reviewed through reactive hyperemia index(RHI)and flow-mediated dilation(FMD).The patients discharge outcomes were recorded,and clinical follow-up was continued after discharge until Aug.2024 or the patient's death.The clinical endpoints were all-cause death and nonfatal major adverse cardiovascular events(MACE).The patients were divided into MACE group(n=84)and non-MACE group(n=164)based on the occurrence of MACEs during follow-up period.The independent predictive factors of MACE were determined by using Cox regression analysis and a nomogram model was established.Results The levels of ICAM1 and VCAM1 were significantly higher in MACE group than those in non-MACE group(P＜0.05),while RHI and FMD were significantly lower than those in non-MACEs group(P＜0.05).The results of multi-factor Cox regression analysis showed that VCAM1,ICAM1,RHI,and FMD were significant predictors of MACE risk in elderly NSTEMI patients following second-generation DES intervention(P＜0.05).A nomogram was constructed based on the multivariate Cox regression results,and results of ROC curve analysis showed that the predictive value of the nomogram model for recurrence risk was 0.781(0.723～0.839),with a model cutoff value of 0.327,sensitivity of 77.38％,and specificity of 68.90％.The results of Kaplan-Meier curve analysis indicated that patients with high levels of ICAM1 or VC AM1 had significantly shorter MACE-free survival times compared to those with low levels of ICAM1 or VC AM1(P＜0.05).Similarly,patients with low RHI or low FMD had significantly shorter MACE-free survival times than those with high RHI or high FMD(P＜0.05).Patients with a combined model scores of vascular endothelial injury-related factors ≥ 3 had significantly shorter MACE-free survival times than those with a combined model scores＜3(P＜0.05).Conclusion High levels of VCAM1 and ICAM1,along with low levels of FMD and RHI,are correlated to a high MACE risk in elderly NSTEMI patients following second-generation DES intervention.The use of a combined model incorporating VCAM1,ICAM1,FMD and RHI can enhance the accuracy of predicting MACE risk in elderly NSTEMI patients.