title: Prognostic significance of endothelial dysfunction in patients undergoing percutaneous coronary intervention in the era of drug-eluting stents.
abstract: BACKGROUND
  Endothelial function is a prognostic predictor in patients undergoing percutaneous coronary intervention (PCI). However, in an era with widespread use of drug-eluting stents, the clinical relevance of endothelial dysfunction on restenosis in patients undergoing PCI has not been fully evaluated.
  
  
  METHODS
  This study included 80 patients with stable angina pectoris. Flow-mediated dilation (FMD) of the brachial artery was examined 1 week after PCI. Patients were retrospectively followed-up for an average of 21 months after PCI. The primary endpoints included cardiac death, nonfatal myocardial infarction, stroke, coronary revascularization, and critical limb ischemia.
  
  
  RESULTS
  A drug-eluting stent was used in 58 patients and a cardiovascular event was recorded in 34 patients during follow-up. The incidence of all cardiovascular diseases was significantly greater in the low FMD (median FMD <4.2%) than the high FMD (median FMD ≥4.2%) group (60% vs. 25%, p <0.01). Furthermore, the incidence of coronary revascularization was significantly higher in the low than the high FMD group (p = 0.02), while the incidence of in-stent restenosis did not differ between the two groups. Cox regression analysis showed that low FMD was an independent predictor of cardiovascular events (hazard ratio: 2.77, 95% confidence interval: 1.23 to 6.19, p = 0.01).
  
  
  CONCLUSIONS
  Impaired brachial artery FMD independently predicts long-term cardiovascular events after PCI in the era of drug-eluting stents.
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. k.moto.39@gmail.com.
authors.forename: Motoki
authors.initials: M
authors.lastname: Kubo
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. miyoshit@cc.okayama-u.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Miyoshi
authors.affiliation: Center of Ultrasonography, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. hirokioe@gmail.com.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Oe
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. he17805@s.okadai.jp.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. ichibun@cc.okayama-u.ac.jp.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. itomd@md.okayama-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001916:Brachial Artery / Q000503:physiopathology*; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000503:physiopathology; D016638:Critical Illness; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D014664:Vasodilation