Abstract 1523: Impact of Changes of Endothelial Function on Cardiovascular Events after Acute Coronary Syndromes
Background: Endothelial function predicts recurrence of adverse cardiac events in patients with acute coronary syndromes (ACS). However, the relationship of changes of endothelial function due to lifestyle modification and optimal medications after ACS with adverse cardiovascular events (CE) is still unclear.
Methods: We studied 98 patients who were hospitalized with ACS. Endothelial function was evaluated noninvasively by measurements of the brachial artery flow-mediated dilation (FMD) at 2 weeks and 6 months after ACS. Each patient was given basic spoken advice on lifestyle modification and optimal medications before discharge. Patients were divided into 4 groups according to changes of FMD after ACS (FMD 3.6% : mean value of all patients at baseline) (shown in Figure⇓). We prospectively followed them until the occurrence of following CE (cardiac death, stroke, myocardial infarction, unstable angina and target vessel revascularization).
Results: During a follow-up period of 16.7±3.2 months, 29 CE were recorded. Kaplan-Meier analysis showed that patients with persistent impaired and worsened endothelial function had a significantly higher incidence of CE (log rank, p=0.002). Multivariate Cox regression analysis showed that the persistent impaired and worsened endothelial function predicted future CE after adjustment for age, risk factors, medications, FMD at baseline (odds ratio 12.3, 95%CI 1.65–78.3, p=0.01: odds ratio 16.5, 95%CI 2.23–97.1, p=0.004; respectively).
Conclusion: Improvement of impaired endothelial function and preservation of normal endothelial function prevent adverse cardiovascular events after ACS.