title: Endothelial Dysfunction After ST-segment Elevation Myocardial Infarction and Long-term Outcome: A Study With Reactive Hyperemia Peripheral Artery Tonometry.
abstract: OBJECTIVE
  Long-term data on the relationship between endothelial dysfunction after ST-segment elevation myocardial infarction and future adverse clinical events are scarce. The aim of this study was to noninvasively assess whether endothelial dysfunction 4 weeks to 6 weeks after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction predicts future clinical events.
  
  
  METHODS
  This prospective cohort study was performed in 70 patients of the RESPONSE randomized trial, who underwent noninvasive assessment of endothelial function 4 weeks to 6 weeks after primary percutaneous coronary intervention. Endothelial function was measured by the reactive hyperemia peripheral artery tonometry method; an index<1.67 identified endothelial dysfunction.
  
  
  RESULTS
  The reactive hyperemia peripheral artery tonometry index measured on average 1.90±0.58. A total of 35 (50%) patients had endothelial dysfunction and 35 (50%) patients had normal endothelial function. Periprocedural "complications" (eg, cardiogenic shock, total atrioventricular block) were more common in patients with endothelial dysfunction than in those without (25.7% vs 2.9%; P<.01). During 4.0±1.7 years of follow-up, 20 (28.6%) patients had major adverse cardiovascular events: events occurred in 9 (25.7%) patients with endothelial dysfunction and in 11 (31.5%) patients with normal endothelial function (P=.52). There was an association between the prevalence of diabetes mellitus at baseline and the occurrence of major adverse cardiovascular events during follow-up (univariate analysis: hazard ratio=2.8; 95% confidence interval, 1.0-7.8; P<.05), and even in multivariate analyses the risk appeared to be increased, although not significantly (multivariate analysis: hazard ratio=2.5; 95% confidence interval, 0.8-7.5).
  
  
  CONCLUSIONS
  In this series of patients who survived an ST-segment elevation myocardial infarction, endothelial dysfunction, as assessed by reactive hyperemia peripheral artery tonometry 4 weeks to 6 weeks after myocardial infarction, did not predict future clinical events during a mean follow-up of 4 years.
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.affiliation: Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: Carine J M
authors.initials: CJ
authors.lastname: Doggen
authors.affiliation: Department of Cardiology, Academisch Medisch Centrum, Amsterdam, The Netherlands.
authors.forename: Harald T
authors.initials: HT
authors.lastname: Jørstad
authors.affiliation: Medlon Laboratory Diagnostics, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: Doelman
authors.affiliation: MESA+, Institute for Nanotechnology, University of Twente, Enschede, The Netherlands.
authors.forename: Bjorn
authors.initials: B
authors.lastname: de Wagenaar
authors.affiliation: Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: IJzerman
authors.affiliation: Department of Cardiology, Academisch Medisch Centrum, Amsterdam, The Netherlands.
authors.forename: Ron J G
authors.initials: RJ
authors.lastname: Peters
authors.affiliation: Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. Electronic address: c.vonbirgelen@mst.nl.
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
mesh_terms: D001158:Arteries / Q000503:physiopathology*; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology*; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors; D014664:Vasodilation / Q000502:physiology*
keywords: Coronary artery disease; Endothelial function (dysfunction); Enfermedad coronaria; Función (disfunción) endotelial; Infarto agudo de miocardio con elevación del segmento ST; Infarto de miocardio; Intervención coronaria percutánea primaria; Myocardial infarction; Primary percutaneous coronary intervention; Reactive hyperemia peripheral artery tonometry; ST-segment elevation myocardial infarction; Tonometría arterial periférica con hiperemia reactiva