title: Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction.
abstract: BACKGROUND
  Coronary endothelial dysfunction is characterized by vasoconstrictive response to the endothelium-dependent vasodilator acetylcholine. Although endothelial dysfunction is considered an early phase of coronary atherosclerosis, there is a paucity of information regarding the outcome of these patients. Thus, this study was designed to evaluate the outcome of patients with mild coronary artery disease on the basis of their endothelial function.
  
  
  RESULTS
  Follow-up was obtained in 157 patients with mildly diseased coronary arteries who had undergone coronary vascular reactivity evaluation by graded administration of intracoronary acetylcholine, adenosine, and nitroglycerin and intracoronary ultrasound at the time of diagnostic study. Patients were divided on the basis of their response to acetylcholine into 3 groups: group 1 (n=83), patients with normal endothelial function; group 2 (n=32), patients with mild endothelial dysfunction; and group 3 (n=42), patients with severe endothelial dysfunction. Over an average 28-month follow-up (range, 11 to 52 months), none of the patients from group 1 or 2 had cardiac events. However, 6 (14%) with severe endothelial dysfunction had 10 cardiac events (P<0.05 versus groups 1 and 2). Cardiac events included myocardial infarction, percutaneous or surgical coronary revascularization, and/or cardiac death.
  
  
  CONCLUSIONS
  Severe endothelial dysfunction in the absence of obstructive coronary artery disease is associated with increased cardiac events. This study supports the concept that coronary endothelial dysfunction may play a role in the progression of coronary atherosclerosis.
authors.affiliation: Center for Coronary Physiology and Imaging, Division of Cardiovascular Diseases, and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Suwaidi
authors.forename: S
authors.initials: S
authors.lastname: Hamasaki
authors.forename: S T
authors.initials: ST
authors.lastname: Higano
authors.forename: R A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: A
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000109:Acetylcholine; D000328:Adult; D000368:Aged; D002560:Cerebrovascular Circulation; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization; D018084:Ultrasonography, Interventional
chemical_list: D000109:Acetylcholine