Impaired Flow-Mediated Dilation and Risk of Restenosis in Patients Undergoing Coronary Stent Implantation

Abstract

Background-Impaired endothelial function is a key event in the atherosclerosis process and predicts future cardiovascular events in subjects with and without coronary artery disease (CAD). We performed the first prospective study evaluating whether early measurement of brachial artery endothelium-dependent dilation (flow-mediated dilation [FMD]) after coronary stenting could predict occurrence of in-stent-restenosis. Methods and Results-The study population included 136 patients with single-vessel CAD undergoing percutaneous coronary intervention (PCI) with stenting and at least 6 months of follow-up. All patients underwent ultrasound detection of brachial artery reactivity 30 days after PCI; FMD was investigated before and after 5 minutes of occlusion of the brachial artery, and nitroglycerin-mediated dilation was investigated before and after administration of sublingual nitrates. Clinical in-stent restenosis was demonstrated in 20 patients (15%), whereas 116 patients (85%) remained free of signs or symptoms of recurrent ischemia. FMD was significantly impaired in patients with restenosis versus those without restenosis (percent diameter variation 4.6Ϯ5.8% versus 9.5Ϯ6.6%, Pϭ0.002); moreover, 4% of patients with FMD Ն7% (median value) developed in-stent restenosis versus 28% of those with FMD Ͻ7% (Pϭ0.0001). On multivariate analysis, FMD was the strongest predictor of restenosis (OR 4.5, 95% CI 2.4 to 12.0); conversely, nitroglycerin-mediated dilation did not independently predict the risk of restenosis (OR 2.4, 95% CI 0.8 to 6.3). Conclusions-This is the first prospective study indicating that impaired FMD independently predicts occurrence of in-stent restenosis in patients undergoing PCI. Early evaluation of endothelial function after stenting may represent a useful screening tool to stratify patients according to future risk of restenosis.

Endothelial Dysfunction, Increased Arterial Stiffness, and Cardiovascular Risk Prediction in Patients With Coronary Artery Disease: FMD‐J (Flow‐Mediated Dilation Japan) Study A

“…Recent meta‐analyses have shown that FMD is a significant predictor of cardiovascular events independent of conventional cardiovascular risk factors 12, 13, 14. However, there have been very few studies in which the predictive value of FMD in patients with established CAD was investigated 29, 30. In addition, the predictive value of FMD in patients with high risk for cardiovascular events is controversial.…”

Diabetic Conditions Differentially Affect the Endothelial Function, Arterial Stiffness and Carotid Atherosclerosis

“…The endothelial function is noninvasively quantified according to the FMD of the brachial artery, which has been shown to be inversely associated with the risk of future cardiovascular events [17][18][19] . Previous studies have demonmm) groups; therefore, the results for %FMD obtained in the present study appear to reflect the actual vasodilatory potency.…”

High Versus Standard Clopidogrel Maintenance Dose After Percutaneous Coronary Intervention and Effects on Platelet Inhibition, Endothelial Function, and Inflammation. Results of the Armyda-150 Mg (Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty) Randomized Study

“…Исследование ARMYDA-150 продемонстрировало дозозависимый эффект клопи-догрела на реактивность плечевой артерии: лечение в дозе 150 мг/день ассоциировалось со статистически значимым улучшением ПЗВД и снижением на 42% доли больных с нарушенной реактивностью плечевой арте-рии (ПЗВД<7%) по сравнению с лечением в дозе 75 мг/день. С учетом данных о связи повышенного рис-ка рестеноза металлического стента без лекарственно-го покрытия (а теоретически и с лекарственным по-крытием) с дисфункцией эндотелия у перенесших ЧКВ больных [23] наши данные могут оказать влияние на практические рекомендации в отношении схемы под-держивающей терапии. Необходимы дальнейшие ис-следования, чтобы определить, связано ли улучшение функции эндотелия при приеме клопидогрела в высокой дозе с ингибированием активности тромбоцитов или с прямым влиянием на эндотелиальные P2Y 12 рецеп-торы [32].…”

“…Анализировались пять сердечных циклов и определялись средние результаты для каждого изображения. В нашем предыдущем проспективном исследовании [23] у больных, подвергающихся ЧКВ с установкой металлического стента без лекарственного покрытия, нарушенная функция эндотелия, опреде-Сравнение высоких и стандартных поддерживающих доз клопидогрела после ЧКВ лявшаяся как ПЗВД <7%, ассоциировалась с повы-шением риска рестеноза стента в 4,5 раза при отда-ленном наблюдении, тогда как ПЗВД ≥7% имела 96%-ное отрицательное предсказательное значение в отношении развития рестеноза.…”