Endothelial Dysfunction After ST-segment Elevation Myocardial Infarction and Long-term Outcome: A Study With Reactive Hyperemia Peripheral Artery Tonometry

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• 作者：Jasveen J. Kandhai-Ragunath^a ; Carine J.M. Doggen^b ; Harald T. Jø ; rstad^c ; Cees Doelman^d ; Bjorn de Wagenaar^e ; Maarten J. IJzerman^b ; Ron J.G. Peters^c ; Clemens von Birgelen^a ; ^b ; ^{c.vonbirgelen@mst.nl" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Endothelial function (dysfunction) ; Reactive hyperemia peripheral artery tonometry ; Myocardial infarction ; ST-segment elevation myocardial infarction ; Primary percutaneous coronary intervention ; Coronary artery disease
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：69
• 期：7
• 页码：664-671
• 全文大小：310 K

文摘

Long-term data on the relationship between endothelial dysfunction after ST-segment elevation myocardial infarction and future adverse clinical events are scarce. The aim of this study was to noninvasively assess whether endothelial dysfunction 4 weeks to 6 weeks after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction predicts future clinical events.

Methods

This prospective cohort study was performed in 70 patients of the RESPONSE randomized trial, who underwent noninvasive assessment of endothelial function 4 weeks to 6 weeks after primary percutaneous coronary intervention. Endothelial function was measured by the reactive hyperemia peripheral artery tonometry method; an index < 1.67 identified endothelial dysfunction.

Results

The reactive hyperemia peripheral artery tonometry index measured on average 1.90 ± 0.58. A total of 35 (50%) patients had endothelial dysfunction and 35 (50%) patients had normal endothelial function. Periprocedural “complications” (eg, cardiogenic shock, total atrioventricular block) were more common in patients with endothelial dysfunction than in those without (25.7% vs 2.9%; P < .01). During 4.0 ± 1.7 years of follow-up, 20 (28.6%) patients had major adverse cardiovascular events: events occurred in 9 (25.7%) patients with endothelial dysfunction and in 11 (31.5%) patients with normal endothelial function (P = .52). There was an association between the prevalence of diabetes mellitus at baseline and the occurrence of major adverse cardiovascular events during follow-up (univariate analysis: hazard ratio = 2.8; 95% confidence interval, 1.0-7.8; P < .05), and even in multivariate analyses the risk appeared to be increased, although not significantly (multivariate analysis: hazard ratio = 2.5; 95% confidence interval, 0.8-7.5).

Conclusions

In this series of patients who survived an ST-segment elevation myocardial infarction, endothelial dysfunction, as assessed by reactive hyperemia peripheral artery tonometry 4 weeks to 6 weeks after myocardial infarction, did not predict future clinical events during a mean follow-up of 4 years.