CLINICAL RESEARCH: ENDOTHELIAL DYSFUNCTION
Endothelial Vasomotor Dysfunction in the Brachial Artery Is Associated With Late In-Stent Coronary Restenosis
Yoshinobu Kitta, MD,
Takamitsu Nakamura, MD,
Yasushi Kodama, MD,
Hajime Takano, MD, PhD,
Ken Umetani, MD, PhD,
Daisuke Fujioka, MD,
Yukio Saito, MD,
Ken-ichi Kawabata, MD, PhD,
Jyun-ei Obata, MD, PhD,
Yoshihide Ichigi, MD,
Akira Mende, MD and
Kiyotaka Kugiyama, MD, PhD*
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.
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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) |
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