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Endothelial vasomotor dysfunction in the brachial artery is associated with late in-stent coronary restenosis.

Abstract：

OBJECTIVES:This study examined whether endothelial dysfunction in the brachial artery might be associated with late in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). BACKGROUND:Simple and noninvasive identification of late ISR might help to select patients who require further angiographic evaluation. METHODS:Endothelium-dependent flow-mediated dilation (FMD) of the brachial artery was measured before (initial FMD) and at six months (follow-up FMD) after PCI in 141 consecutive patients who had elective and successful PCI with bare metal stents in de novo lesions of native coronary arteries for symptomatic coronary artery disease. Follow-up angiography was performed at six months after PCI in all patients. RESULTS:With multivariate logistic regression analysis, the impairment (< or = 4.8% dilation from baseline diameter) of FMD at follow-up showed the strongest association with late ISR (defined as > 50% diameter stenosis, n = 46) independently of other clinical and angiographic variables known to be associated with ISR (odds ratio 7.4, 95% confidence interval 2.8 to 19.2, p < 0.001), whereas the initial FMD did not have the association. The sensitivity of impaired FMD at follow-up (69%) in detecting ISR was higher than chest pain during the follow-up period (45%), with comparable specificity. The impaired FMD in combination with the chest pain increased the sensitivity to 90%. CONCLUSIONS:The impairment of FMD in the brachial artery at the time of follow-up was independently and closely associated with late ISR in native coronary arteries. The noninvasive assessment of FMD at the time of follow-up might be useful for identification of late ISR.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kitta Y,Nakamura T,Kodama Y,Takano H,Umetani K,Fujioka D,Saito Y,Kawabata K,Obata JE,Ichigi Y,Mende A,Kugiyama K

doi

10.1016/j.jacc.2005.04.055

subject

Has Abstract

pub_date

2005-08-16 00:00:00

pages

648-55

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(05)01176-9

journal_volume

pub_type

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Endothelial vasomotor dysfunction in the brachial artery is associated with late in-stent coronary restenosis.