title: Endothelial vasomotor dysfunction in the brachial artery is associated with late in-stent coronary restenosis.
abstract: OBJECTIVE
  This study examined whether endothelial dysfunction in the brachial artery might be associated with late in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Simple and noninvasive identification of late ISR might help to select patients who require further angiographic evaluation.
  
  
  METHODS
  Endothelium-dependent flow-mediated dilation (FMD) of the brachial artery was measured before (initial FMD) and at six months (follow-up FMD) after PCI in 141 consecutive patients who had elective and successful PCI with bare metal stents in de novo lesions of native coronary arteries for symptomatic coronary artery disease. Follow-up angiography was performed at six months after PCI in all patients.
  
  
  RESULTS
  With multivariate logistic regression analysis, the impairment (< or = 4.8% dilation from baseline diameter) of FMD at follow-up showed the strongest association with late ISR (defined as > 50% diameter stenosis, n = 46) independently of other clinical and angiographic variables known to be associated with ISR (odds ratio 7.4, 95% confidence interval 2.8 to 19.2, p < 0.001), whereas the initial FMD did not have the association. The sensitivity of impaired FMD at follow-up (69%) in detecting ISR was higher than chest pain during the follow-up period (45%), with comparable specificity. The impaired FMD in combination with the chest pain increased the sensitivity to 90%.
  
  
  CONCLUSIONS
  The impairment of FMD in the brachial artery at the time of follow-up was independently and closely associated with late ISR in native coronary arteries. The noninvasive assessment of FMD at the time of follow-up might be useful for identification of late ISR.
authors.affiliation: Department of Internal Medicine II, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kitta
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kodama
authors.forename: Hajime
authors.initials: H
authors.lastname: Takano
authors.forename: Ken
authors.initials: K
authors.lastname: Umetani
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fujioka
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saito
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Kawabata
authors.forename: Jyun-ei
authors.initials: JE
authors.lastname: Obata
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Ichigi
authors.forename: Akira
authors.initials: A
authors.lastname: Mende
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Kugiyama
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001916:Brachial Artery / Q000503:physiopathology*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors