Original articleEndothelial Dysfunction After ST-segment Elevation Myocardial Infarction and Long-term Outcome: A Study With Reactive Hyperemia Peripheral Artery TonometryDisfunción endotelial tras infarto de miocardio con elevación del segmento ST y evolución a largo plazo: un estudio con tonometría arterial periférica e hiperemia reactiva
Section snippets
INTRODUCTION
Endothelial dysfunction of coronary conductance and resistance vessels, which is more often observed in the presence of certain cardiovascular risk factors, contributes significantly to the process of artherogenesis1, 2, 3, 4, 5 and may cause myocardial ischemia.6, 7, 8 The improvement of clinical outcome in response to modification of risk factors may primarily be the result of functional recovery of the impaired coronary vasomotor function, while structural changes of the atherosclerotic
Study Population and Design
This prospective cohort study was performed in 70 STEMI patients of the RESPONSE trial,24 who underwent treatment by PPCI for acute STEMI (≤ 12 hours after symptom onset) and noninvasive assessment of endothelial function with the RH-PAT method after 4 weeks to 6 weeks. The PPCI were performed between October 2007 and December 2008 at Thoraxcentrum Twente. Of a total of 75 STEMI patients of the RESPONSE trial with RH-PAT measurements, 71 had analyzable RH-PAT registrations, and follow-up was
Patient and Procedural Characteristics, in-hospital Course, and Endothelial Function
Of all 70 patients, who had a mean age of 56.9 ± 9.6 years, 55 (78.6%) were men. Primary PCI procedures were performed via the femoral route in all but one patient (98.4%); eight patients (11.4%) had prior percutaneous intervention and 1 (1.4%) had a history of coronary artery bypass grafting; manual thrombus aspiration was performed in 38 (62.3%), direct stenting in 36 (51.4%), and stent postdilatation in 56 (93.3%) patients. At discharge, the left venticular ejection fraction was preserved (>
DISCUSSION
While endothelial dysfunction is a key component of atherogenesis, contributes to the development of cardiovascular disease, and predicts outcome in patients with or without overt coronary artery disease,1, 2, 3, 4, 5, 6, 7 its significance for the highest risk category—patients with STEMI—was less certain. In the present prospective cohort study in STEMI patients of the RESPONSE trial that involved medical treatment according to evidence-based pharmacological concepts,24 endothelial
CONCLUSIONS
In this series of patients who survived a STEMI, endothelial dysfunction, as assessed by RH-PAT 4 weeks weeks to 6 weeks from PPCI, did not predict future MACE during an average follow-up of 4 years. Future large-scale studies with other techniques to assess endothelial dysfunction after PPCI may still be warranted.
CONFLICTS OF INTEREST
The research department of Thoraxcentrum Twente has received research grants funded by AstraZeneca, Biotronik, Boston Scientific, and Medtronic. C. von Birgelen has been a consultant for Boston Scientific and Medtronic, and has received lecture fees from AstraZeneca and MSD. R. J. G. Peters has been a consultant for Amgen, AstraZeneca, and Sanofi, and has received lecture fees from AstraZeneca, Boehringer Ingelheim, and Sanofi.
References (40)
- et al.
Evidence that selective endothelial dysfunction may occur in the absence of angiographic or ultrasound atherosclerosis in patients with risk factors for atherosclerosis
J Am Coll Cardiol.
(1994) Endothelial dysfunction: does it matter? Is it reversible?
J Am Coll Cardiol.
(1997)- et al.
El enriquecimiento de la dieta con polifenoles previene la disfunción endotelial coronaria mediante la activación de la vía de Akt/eNOS
Rev Esp Cardiol.
(2015) Epidemiología de la enfermedad arterial coronaria
Rev Esp Cardiol.
(2014)- et al.
Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease
J Am Coll Cardiol.
(2003) - et al.
Prognostic value of flow-mediated dilatation following myocardial infarction
Int J Cardiol.
(2009) - et al.
Close relation of endothelial function in human coronary and peripheral circulations
J Am Coll Cardiol.
(1995) - et al.
Systemic endothelial dysfunction is related to the extent and severity of coronary artery disease
Atherosclerosis.
(1997) - et al.
Assessment of peripheral vascular endothelial function with finger arterial pulse wave amplitude
Am Heart J.
(2003) - et al.
Non-invasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia
J Am Coll Cardiol.
(2004)