Abstract 9735: Endothelial Vasomotor Function in the Brachial Artery is Associated with Long-term Cardiovascular Events in Patients after Implantation of Drug Eluting-Stent

Abstract

Endothelial dysfunctionin systemic arteries is a predictor of long-term coronary events. Although drug eluting-stent (DES) implantation aggravates coronary artery endothelial vasomotor dysfunction, it remains unclear endothelial dysfunction in systemic arteries provides prognostic information in coronary artery disease (CAD) patients after implantation of DES. Thus, we examined whether endothelial dysfunction may predict future cardiovascular events in CAD patients after implantation of DES. Methods: This study included 231 consecutive patients with newly diagnosed CAD who had elective and successful PCI with DES in de novo lesions of native coronary arteries. Measurement of FMD (expressed as percent dilation from baseline brachial artery diameter) during reactive hyperemia was performed by high-resolution ultrasound at entry (before PCI) and after 6months. All patients had individualized, optimized therapies including medications and recommended life style changes to reduce risk factors for CAD according to AHA guidelines. Patients were prospectively followed up until the occurrence of 1 of the following events: cardiovascular death, recurrent or refractory angina pectoris, nonfatal myocardial infarction, and ischemic stroke. The impairment of FMD was defined as < 5.5% (mean minus 1SD of FMD in 100 age- and sex-matched normal subjects in our hospital). Results: Impaired FMD (<5.5%) was in 86 (37%) patients after 6months. During a follow-up period of 30 ± 0.8 months, events occurred in 19 patients of the 86 patients with impaired FMD after 6months. Using multivariate Cox hazards analysis, impaired FMD after 6months was a predictor of future cardiovascular events that was independent of impaired FMD at entry, use of medications, age, and traditional CAD risk factors (odds ratio 2.9, 95%CI 1.3 - 6.2, p < 0.01) Conclusions: Endothelial dysfunction in the brachial artery represents an adverse outcome in CAD patients after implantation of DES. Measurement of FMD may be useful for risk stratification in CAD patients after implantation of DES.