Endothelial vasomotor dysfunction in the brachial artery is associated with late in-stent coronary restenosis.
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.
Kitta
Yoshinobu
Y
Department of Internal Medicine II, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.
Nakamura
Takamitsu
T
Kodama
Yasushi
Y
Takano
Hajime
H
Umetani
Ken
K
Fujioka
Daisuke
D
Saito
Yukio
Y
Kawabata
Ken-ichi
K
Obata
Jyun-ei
JE
Ichigi
Yoshihide
Y
Mende
Akira
A
Kugiyama
Kiyotaka
K
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