title: Association of coronary microvascular dysfunction with restenosis of left anterior descending coronary artery disease treated by percutaneous intervention.
abstract: BACKGROUND
  Several patients with successful percutaneous coronary interventions (PCIs) show evidence of coronary microvascular dysfunction (CMVD), which can be responsible for persistent positivity of electrocardiographic exercise stress test (EST). In this study, we assessed whether post-PCI CMVD may predict clinical outcome in patients undergoing successful elective PCI of an isolated stenosis of the left anterior descending (LAD) coronary artery.
  
  
  METHODS
  We studied 29 patients (age 64±6, 23 M) with stable coronary artery disease and isolated stenosis (>75%) of the LAD coronary artery who underwent successful PCI with stent implantation. Coronary blood flow (CBF) velocity response to adenosine and to cold-pressor test (CPT) was assessed in the LAD coronary artery by transthoracic Doppler echocardiography 24h and 3months after PCI. The primary end-point was a combination of death, admission for acute coronary syndromes (ACS) or target vessel revascularization (TVR).
  
  
  RESULTS
  No death or ACS occurred during 36months of follow-up, but TVR was performed in 5 patients (17.2%). CBF response to CPT at 3months after PCI was 1.31±0.2 vs. 1.71±0.4 in patients with or without TVR, respectively (p=0.03), whereas CBF response to adenosine at 3months in these two groups was 1.70±0.3 vs. 2.05±0.4 (p=0.059).
  
  
  CONCLUSIONS
  Our data suggest that, in patients with successful PCI of LAD coronary artery stenosis, lower CBF response to the endothelium-dependent vasodilator stimulus CPT is associated with long-term recurrence of restenosis.
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: De Vita
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Milo
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Sestito
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Lamendola
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy. Electronic address: gaetanoantonio.lanza@unicatt.it.
authors.forename: Gaetano A
authors.initials: GA
authors.lastname: Lanza
authors.affiliation: Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D003326:Coronary Circulation / Q000502:physiology; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology* / Q000601:surgery; D004452:Echocardiography / Q000639:trends; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000639:trends*; D016896:Treatment Outcome
keywords: Coronary microvascular dysfunction; Exercise stress test; Percutaneous coronary intervention; Restenosis