title: Assessment of the relation between initial culprit vessel patency in acute ST-elevation myocardial infarction and endothelial function.
abstract: OBJECTIVE
  To assess whether better endothelial function increases the likelihood of patients with acute ST-elevation myocardial infarction (STEMI) having initially patent culprit vessels. Clinical data on the relation between endothelial function and culprit vessel patency in STEMI patients are scarce.
  
  
  RESULTS
  In this prospective cohort study in 71 patients with STEMI, endothelial function was non-invasively assessed by use of the reactive hyperaemia peripheral artery tonometry (RH-PAT) method at four to six weeks after the primary percutaneous coronary intervention (PPCI). The RH-PAT index measured on average 1.90±0.58. In patients with patent culprit vessels before PPCI (n=33, 46.5%), endothelial function was significantly better than in patients with occluded vessels (n=38, 53.5%) (RH-PAT index 2.08±0.34 vs. 1.75±0.35; p<0.007). Compared to patients with normal endothelial function, the patients with severe endothelial dysfunction had a fivefold higher risk of presenting with an occluded culprit vessel (OR 5.1, 95% CI: 1.8-14.2). Logistic regression analysis revealed that this relation between endothelial function and vessel patency became even stronger after adjustment for potential confounders (adjusted OR 7.1, 95% CI: 2.1-23.6).
  
  
  CONCLUSIONS
  In this series of patients with acute STEMI, better endothelial function was independently associated with a higher likelihood of presenting with an initially patent culprit vessel.
authors.affiliation: Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Jasveen J
authors.initials: JJ
authors.lastname: Kandhai-Ragunath
authors.forename: Harald T
authors.initials: HT
authors.lastname: Jørstad
authors.forename: Bjorn
authors.initials: B
authors.lastname: de Wagenaar
authors.forename: Frits H A F
authors.initials: FH
authors.lastname: de Man
authors.forename: Martin G
authors.initials: MG
authors.lastname: Stoel
authors.forename: Jan
authors.initials: J
authors.lastname: van Es
authors.forename: Cees J A
authors.initials: CJ
authors.lastname: Doelman
authors.forename: Carine J M
authors.initials: CJ
authors.lastname: Doggen
authors.forename: Ron J G
authors.initials: RJ
authors.lastname: Peters
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D011446:Prospective Studies; D014654:Vascular Patency