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CLINICAL STUDY: ENDOTHELIAL FUNCTION

Early dysfunction and long-term improvement in endothelium-dependent vasodilation in the infarct-related artery after thrombolysis

^a Servei de Cardiologia, Hospital de Bellvitge, Universitat de Barcelona, Barcelona, Spain

Manuscript received October 11, 2001; revised manuscript received April 4, 2002, accepted April 18, 2002.

^* Reprint requests and correspondence: Dr. Angel Cequier, Unitat d’Hemodinàmica i Cardiologia Intervencionista, Servei de Cardiologia, Hospital de Bellvitge, C/Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907 Barcelona, Spain.
acequier{at}csub.scs.es

OBJECTIVES: This study assessed the degree of endothelial dysfunction in post-acute myocardial infarction (AMI) and its subsequent status in the infarct-related artery (IRA) in patients treated with thrombolysis.

BACKGROUND: Coronary flow reserve alterations in the IRA after thrombolysis have been described, but the endothelium-dependent vasomotion has not been investigated, to date.

METHODS: Endothelial function in patients after thrombolysis was assessed by infusion of acetylcholine (ACh) at increasing doses in the IRA. Diameter changes in the distal segments were evaluated using quantitative coronary angiography. Patients with coronary atherosclerosis constituted the control group. Clinical variables, electrocardiography and biochemical markers were used to determine the timing of reperfusion and the extent of the infarct. Patients in the AMI group were re-evaluated one year later.

RESULTS: In the initial assessment, 16 patients showed a vasoconstriction response to ACh in the IRA compared to the control group (–20 ± 21% vs. 4 ± 4%; p < 0.01). Significant correlations between the degree of vasoconstriction and maximum value of the creatine kinase-MB fraction and number of new Q waves were observed. Of the 12 patients re-evaluated, 4 had complete occlusion of the IRA. In the remaining eight patients with patent artery, an improvement in response to ACh was observed relative to the initial study (+3 ± 11%, vs. –19 ± 15%, p < 0.05).

CONCLUSIONS: In patients with AMI treated with thrombolysis, severe endothelial dysfunction in the IRA is observed early. In patients who retain patency of the IRA, the endothelial dysfunction improves during the follow-up and suggests a component of stunned endothelium in the first few days post-AMI.

Abbreviations and Acronyms   ACE   angiotensin-converting enzyme   ACh   acetylcholine   AMI   acute myocardial infarction   ANOVA   analysis of variance   AUC   area under the curve   CK-MB   creatine kinase-MB fraction   ECG   electrocardiogram   IRA   infarct-related artery   MI   myocardial infarction   NTG   nitroglycerin   TIMI   Thrombolysis In Myocardial Infarction trial

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