Impaired flow-mediated dilation and risk of restenosis in patients undergoing coronary stent implantation.
BACKGROUND
Impaired endothelial function is a key event in the atherosclerosis process and predicts future cardiovascular events in subjects with and without coronary artery disease (CAD). We performed the first prospective study evaluating whether early measurement of brachial artery endothelium-dependent dilation (flow-mediated dilation [FMD]) after coronary stenting could predict occurrence of in-stent-restenosis.


RESULTS
The study population included 136 patients with single-vessel CAD undergoing percutaneous coronary intervention (PCI) with stenting and at least 6 months of follow-up. All patients underwent ultrasound detection of brachial artery reactivity 30 days after PCI; FMD was investigated before and after 5 minutes of occlusion of the brachial artery, and nitroglycerin-mediated dilation was investigated before and after administration of sublingual nitrates. Clinical in-stent restenosis was demonstrated in 20 patients (15%), whereas 116 patients (85%) remained free of signs or symptoms of recurrent ischemia. FMD was significantly impaired in patients with restenosis versus those without restenosis (percent diameter variation 4.6+/-5.8% versus 9.5+/-6.6%, P=0.002); moreover, 4% of patients with FMD > or =7% (median value) developed in-stent restenosis versus 28% of those with FMD <7% (P=0.0001). On multivariate analysis, FMD was the strongest predictor of restenosis (OR 4.5, 95% CI 2.4 to 12.0); conversely, nitroglycerin-mediated dilation did not independently predict the risk of restenosis (OR 2.4, 95% CI 0.8 to 6.3).


CONCLUSIONS
This is the first prospective study indicating that impaired FMD independently predicts occurrence of in-stent restenosis in patients undergoing PCI. Early evaluation of endothelial function after stenting may represent a useful screening tool to stratify patients according to future risk of restenosis.
Patti
Giuseppe
G
Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
Pasceri
Vincenzo
V
Melfi
Rosetta
R
Goffredo
Costanza
C
Chello
Massimo
M
D'Ambrosio
Andrea
A
Montesanti
Rosamaria
R
Di Sciascio
Germano
G
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D015331:Cohort Studies; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D023921:Coronary Stenosis / Q000503:physiopathology / Q000628:therapy*; D048909:Diabetes Complications; D018572:Disease-Free Survival; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D018056:Hemorheology; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D015607:Stents; D014463:Ultrasonography; D014664:Vasodilation
D000806:Angiotensin-Converting Enzyme Inhibitors