Impaired Peripheral Endothelial Function Assessed by Digital Reactive Hyperemia Peripheral Arterial Tonometry and Risk of In-Stent Restenosis.
Drug-eluting stents are replacing bare-metal stents, but in-stent restenosis (ISR) remains a problem. Reactive hyperemia index (RHI) assessed by peripheral arterial tonometry evaluates endothelial function noninvasively. We prospectively assessed the prognostic value of RHI in predicting ISR after percutaneous coronary intervention.



RHI was measured before percutaneous coronary intervention and at follow-up (F/U) angiography (F/U RHI; 6 and 9 months post bare-metal stents- and drug-eluting stents- percutaneous coronary intervention, respectively) in 249 consecutive patients. At F/U, ISR (stenosis >50% of diameter) was seen in 68 patients (27.3%). F/U natural logarithm (RHI) was significantly lower in patients with ISR than in those without (0.52±0.23 versus 0.65±0.27, P<0.01); no between-group difference in initial natural logarithm (RHI) (0.60±0.26 versus 0.62±0.25, P=0.56) was seen. By multivariate logistic regression analysis, even after adjusting for other significant parameters in univariate analysis, F/U natural logarithm (RHI) independently predicted ISR (odds ratio: 0.13; 95% CI: 0.04-0.48; P=0.002). In receiver operating-characteristic analysis, F/U RHI was the strongest predictor of ISR (area under the curve: 0.67; 95% CI: 0.60-0.75; P<0.01; RHI <1.73 had 67.6% sensitivity, 64.1% specificity); area under the curve significantly improved from 0.62 to 0.70 when RHI was added to traditional ISR risk factors (P=0.02). Net reclassification index was significant after addition of RHI (26.5%, P=0.002).



Impaired RHI at F/U angiography independently correlated with ISR, adding incremental prognostic value to the ISR-risk stratification following percutaneous coronary intervention.



URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02131935.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Naohiro
N
Komura
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan tsujita@kumamoto-u.ac.jp.
Kenichi
K
Tsujita
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Kenshi
K
Yamanaga
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Kenji
K
Sakamoto
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Koichi
K
Kaikita
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Seiji
S
Hokimoto
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Satomi
S
Iwashita
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Takashi
T
Miyazaki
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Tomonori
T
Akasaka
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Yuichiro
Y
Arima
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Eiichiro
E
Yamamoto
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Yasuhiro
Y
Izumiya
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Megumi
M
Yamamuro
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Sunao
S
Kojima
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Shinji
S
Tayama
Jinnouchi Hospital, Kumamoto, Japan.
Seigo
S
Sugiyama
Department of Community Medicine, Kumamoto University, Kumamoto, Japan.
Kunihiko
K
Matsui
New Tokyo Hospital, Matsudo, Japan.
Sunao
S
Nakamura
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Kiyoshi
K
Hibi
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Kazuo
K
Kimura
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Satoshi
S
Umemura
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Hisao
H
Ogawa
D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000601:surgery; D023903:Coronary Restenosis / Q000209:etiology* / Q000503:physiopathology; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000502:physiology; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006940:Hyperemia / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008365:Manometry / Q000379:methods; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
endothelial dysfunction; reactive hyperemia; reactive hyperemia–peripheral arterial tonometry; restenosis; risk factor; stent