Impaired flow-mediated dilation and risk of restenosis in patients undergoing coronary stent implantation

• Published in: Circulation (New York, N.Y.) Vol. 111; no. 1; pp. 70 - 75
• Main Authors: PATTI, Giuseppe, PASCERI, Vincenzo, MELFI, Rosetta, GOFFREDO, Costanza, CHELLO, Massimo, D'AMBROSIO, Andrea, MONTESANTI, Rosamaria, DI SCIASCIO, Germano
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 04-01-2005
• Subjects: Aged; Angioplasty, Balloon, Coronary; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Brachial Artery - diagnostic imaging; Brachial Artery - physiopathology; Cardiology. Vascular system; Cohort Studies; Coronary heart disease; Coronary Restenosis - epidemiology; Coronary Restenosis - etiology; Coronary Restenosis - physiopathology; Coronary Stenosis - physiopathology; Coronary Stenosis - therapy; Diabetes Complications; Disease-Free Survival; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endothelium, Vascular - physiopathology; Endothelium, Vascular - secretion; Female; Follow-Up Studies; Heart; Hemorheology; Humans; Life Tables; Male; Medical sciences; Middle Aged; Predictive Value of Tests; Prospective Studies; Risk; Stents; Ultrasonography; Vasodilation; Human; Restenosis; stents; Risk factor; Cardiovascular disease; Coronary heart disease; Stent; Endothelium
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.0000151308.06673.d2

Impaired endothelial function is a key event in the atherosclerosis process and predicts future cardiovascular events in subjects with and without coronary artery disease (CAD). We performed the first prospective study evaluating whether early measurement of brachial artery endothelium-dependent dilation (flow-mediated dilation [FMD]) after coronary stenting could predict occurrence of in-stent-restenosis.
The study population included 136 patients with single-vessel CAD undergoing percutaneous coronary intervention (PCI) with stenting and at least 6 months of follow-up. All patients underwent ultrasound detection of brachial artery reactivity 30 days after PCI; FMD was investigated before and after 5 minutes of occlusion of the brachial artery, and nitroglycerin-mediated dilation was investigated before and after administration of sublingual nitrates. Clinical in-stent restenosis was demonstrated in 20 patients (15%), whereas 116 patients (85%) remained free of signs or symptoms of recurrent ischemia. FMD was significantly impaired in patients with restenosis versus those without restenosis (percent diameter variation 4.6+/-5.8% versus 9.5+/-6.6%, P=0.002); moreover, 4% of patients with FMD > or =7% (median value) developed in-stent restenosis versus 28% of those with FMD <7% (P=0.0001). On multivariate analysis, FMD was the strongest predictor of restenosis (OR 4.5, 95% CI 2.4 to 12.0); conversely, nitroglycerin-mediated dilation did not independently predict the risk of restenosis (OR 2.4, 95% CI 0.8 to 6.3).
This is the first prospective study indicating that impaired FMD independently predicts occurrence of in-stent restenosis in patients undergoing PCI. Early evaluation of endothelial function after stenting may represent a useful screening tool to stratify patients according to future risk of restenosis.