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CLINICAL RESEARCH: ENDOTHELIAL DYSFUNCTION

Endothelial Vasomotor Dysfunction in the Brachial Artery Is Associated With Late In-Stent Coronary Restenosis

Department of Internal Medicine II, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan

Manuscript received January 23, 2005; revised manuscript received April 19, 2005, accepted April 25, 2005.

^_* Reprint requests and correspondence: Dr. Kiyotaka Kugiyama, Department of Internal Medicine II, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Nakakoma-gun, Yamanashi, 409-3898 Japan (Email: kugiyama{at}yamanashi.ac.jp).

OBJECTIVES: This study examined whether endothelial dysfunction in the brachial artery might be associated with late in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).

BACKGROUND: Simple and noninvasive identification of late ISR might help to select patients who require further angiographic evaluation.

METHODS: Endothelium-dependent flow-mediated dilation (FMD) of the brachial artery was measured before (initial FMD) and at six months (follow-up FMD) after PCI in 141 consecutive patients who had elective and successful PCI with bare metal stents in de novo lesions of native coronary arteries for symptomatic coronary artery disease. Follow-up angiography was performed at six months after PCI in all patients.

RESULTS: With multivariate logistic regression analysis, the impairment (4.8% dilation from baseline diameter) of FMD at follow-up showed the strongest association with late ISR (defined as >50% diameter stenosis, n = 46) independently of other clinical and angiographic variables known to be associated with ISR (odds ratio 7.4, 95% confidence interval 2.8 to 19.2, p < 0.001), whereas the initial FMD did not have the association. The sensitivity of impaired FMD at follow-up (69%) in detecting ISR was higher than chest pain during the follow-up period (45%), with comparable specificity. The impaired FMD in combination with the chest pain increased the sensitivity to 90%.

CONCLUSIONS: The impairment of FMD in the brachial artery at the time of follow-up was independently and closely associated with late ISR in native coronary arteries. The noninvasive assessment of FMD at the time of follow-up might be useful for identification of late ISR.

Abbreviations and Acronyms   CAD = coronary artery disease   ECG = electrocardiography   FMD = flow-mediated dilation   HDL-C = high-density lipoprotein cholesterol   hsCRP = high-sensitivity C-reactive protein   ISR = in-stent restenosis   MLD = minimal lumen diameter   PCI = percutaneous coronary intervention   TLR = target lesions revascularization (defined as repeat percutaneous coronary intervention of the original stented target lesions)