Abstract 2869: Coronary Endothelial Dysfunction Highly Predicts Multiple Adverse Cardiovascular Events in Patients With Coronary Artery Disease During Long-Term Follow-up Over 10 Years
Introduction and hypothesis: Although coronary endothelial dysfunction is thought to affect coronary atherothrombogenic processes, there has been little practical evidence for the relationship. We assessed hypothesis that coronary endothelial dysfunction has multiple prognostic impacts for the patients with coronary artery disease.
Methods: Coronary endothelial dysfunction was practically graded by the endothelium-dependent reactive changes in coronary artery diameter (DATP) to infusion of ATP (50 μg) into the normal left coronary artery using quantitative coronary arteriography in 150 patients with stable coronary artery disease. The enrolled patients were categorized into 3 groups according to the values of DATP, and we prospectively followed-up their major adverse clinical cardiovascular events (cardiovascular death, acute coronary syndrome, stroke).
Results: For a mean follow-up period of 132 months (range; 120 to 144), the patients in the lower third with severe endothelial dysfunction (Group-L, n = 50) more frequently developed both acute coronary syndrome and stroke than those in the middle third with mild endothelial dysfunction (Group-M, n = 50) or the upper third with normal endothelial function (Group-H), by Kaplan-Meier analysis. Majority of the patients who resulted in cardiovascular death belonged to Group-L. Cox hazard proportional model analyses indicated severe endothelial dysfunction determined by DATP was the strong predictor for acute coronary syndrome (hazard ratio = 4.17, 95%confidential interval; 1.42–7.93, p = 0.016), for stroke (hazard ratio = 5.44, 95%confidential interval; 1.09 –9.84, p = 0.039), and for cardiovascular death (hazard ratio = 13.50, 95%confidential interval; 1.55–25.25, p = 0.005).
Conclusion: This is the novel and longest follow-up study that demonstrates coronary endothelial dysfunction provides multiple prognostic impacts on fatal and nonfatal clinical manifestation of cardiovascular events.