Peripheral Artery Tonometry Reveals Impaired Endothelial Function before Percutaneous Coronary Intervention in Patients with Periprocedural Myocardial Injury.

Zhangwei Chen,Juying Qian,Yan Xia,Danbo Lu,You Zhou,Jiasheng Yin,Ao Chen,Dong Huang,Junbo Ge,Qinglai Gao,Martin J Swaans

doi:10.1155/2021/5598120

Abstract

Background Periprocedural myocardial injury (PMI) is a most common complication of percutaneous coronary intervention (PCI). Microembolization and inflammation underlying PMI could lead to coronary microvascular dysfunction (CMD) and vice versa. Reactive hyperemia index (RHI) assessed by peripheral artery tonometry (PAT) has been considered as a noninvasive method to assess endothelial function and CMD, which could be useful to predict PMI. Methods 268 patients suspected with stable coronary artery disease (CAD) and scheduled for elective coronary angiography were enrolled. RHI was measured by using the Endo-PAT2000™ device before angiography. The association among RHI, PMI, and cardiovascular events was further assessed. Results In this cohort, 189 patients (70.5%) were diagnosed with CAD and 119 patients (44.4%) underwent drug-eluting stent (DES) implantation. Compared with patients without CAD, CAD patients had lower RHI (1.88 ± 0.55 vs. 2.02 ± 0.58, P < 0.05). Patients with PMI had a lower RHI before angiography (1.75 ± 0.37 vs. 1.95 ± 0.50, P < 0.05). Receiver operating characteristic curve analysis of RHI revealed an area under the curve (AUC) of 0.61, with a sensitivity of 62.7% and specificity of 50.0% to predict PMI. Moreover, we found that CAD patients with RHI ≤ 1.81 had a higher incidence of composite cardiac events after stenting (adjusted hazard ratio (HR) 3.31, 95% confidence interval (CI) 1.07–10.22, P < 0.05). Conclusions RHI assessment through PAT could be a promising method to predict PMI before the procedure. RHI is associated with increased risk of long-term adverse cardiac events after DES implantation.

Highlights

percutaneous coronary intervention (PCI) has been a standard approach to achieve revascularization of obstructive coronary coronary artery disease (CAD). e improvement of techniques and equipment dramatically decreases the incidence of severe complications after PCI, such as stent thrombosis, perforation, and death [1]
Previous studies imply an association between Periprocedural myocardial injury (PMI) and adverse cardiovascular events [4,5,6]. e diagnosis of PMI depends on the values of cardiac troponin or creatine kinaseMB (CK-MB) after the procedure
When PMI was defined as a postPCI cTnT value > 99% URL, 51 out of the 119 patients (42.9%) had PMI

Summary

Introduction

PCI has been a standard approach to achieve revascularization of obstructive coronary CAD. e improvement of techniques and equipment dramatically decreases the incidence of severe complications after PCI, such as stent thrombosis, perforation, and death [1]. PAT, which detects the reactive hyperemia-induced changes in digital peripheral pulse amplitude to evaluate peripheral endothelial function [12], was closely related with cardiovascular risk factors [13] and considered as a valuable noninvasive way to evaluate coronary microvascular function [14, 15]. PATcould be a useful method to identify patients at high risk of PMI before the procedure. Reactive hyperemia index (RHI) assessed by peripheral artery tonometry (PAT) has been considered as a noninvasive method to assess endothelial function and CMD, which could be useful to predict PMI. We found that CAD patients with RHI ≤ 1.81 had a higher incidence of composite cardiac events after stenting (adjusted hazard ratio (HR) 3.31, 95% confidence interval (CI) 1.07–10.22, P < 0.05). RHI is associated with increased risk of long-term adverse cardiac events after DES implantation

Methods

Results

Conclusion