Abstract
Background: Provoked spasm might have influence on cardiovascular events even after successful DES implantation. Methods and results: A consecutive 122 patients who underwent first-generation DES (CypherTM, and TaxusTM) implantation and had no residual stenosis at follow-up coronary angiography were included. All patients also underwent acetylcholine provocation test (ACh) at follow-up angiography. Age, sex, coronary risk factors (smoking, hypertension, diabetes mellitus, dyslipidemia), medication (calcium channel blockers, angiotensin receptor blockers, angiotensin converting enzyme inhibitors, nitrates, β blockers, statins), duration from stent implantation to follow-up angiography (15.5 ± 14.5 months), old myocardial infarction, Ach + were included as variables for multivariate analysis for cardiovascular events (angina pectoris without intervention, target lesion revascularization, acute myocardial infarction, definite or probable stent thrombosis, cardiac death, and stroke). ACh provocation test was positive in 64.8%. The following events occurred during a mean follow-up period of 26.9 ± 9.5 months; angina pectoris without intervention in 12, very late stent thrombosis in 1, acute myocardial infarction in 1, sudden death in 1, and stroke in 4. By Adjusted Cox hazard model, age was the independent predictor of future cardiovascular events. ACh was unbalanced data for Cox hazard model, and by logistic regression model, ACh was the strongest predictor. Conclusions: Coronary endothelial dysfunction at chronic stage is the strongest predictor of further prognosis in patients with first-generation DES.
Highlights
Due to reduced restenosis rate after drug-eluting stents (DES) implantation and improved skills, it is important to manage patients with non-stenotic coronary trees for better long-term clinical outcomes
We try to know whether acetylcholine provocation test (ACh) induced spasm at stable stage is related to the incidence of cardiovascular events during further follow-up in Japanese patients who had been reported to possess an ethnic propensity for coronary vasospasm [23,24]
Follow-up coronary angiography was performed as a routine management 8 - 12 months after stent implantation irrespective of symptoms, it was delayed in some patients due to convenience of patients
Summary
Due to reduced restenosis rate after drug-eluting stents (DES) implantation and improved skills, it is important to manage patients with non-stenotic coronary trees for better long-term clinical outcomes. Endothelial dysfunction has been recognized in patients with DES [1,2,3,4,5,6,7,8,9,10,11,12,13], little is known about its clinical significance, especially about prognostic one. Patients with atherosclerotic coronary lesions might be at higher risk of coronary endothelial dysfunction after DES implantation. S. Ito et al / World Journal of Cardiovascular Diseases 3 (2013) 25-32 related endothelial dysfunction produces a similar risk is not known [8]. We try to know whether acetylcholine provocation test (ACh) induced spasm at stable stage is related to the incidence of cardiovascular events during further follow-up in Japanese patients who had been reported to possess an ethnic propensity for coronary vasospasm [23,24]
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