Abstract 4266: Coronary Endothelial Dysfunction Promotes not only Angiographical Progression but Also Clinical Manifestation 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 tertile groups according to the values of DATP, and we prospectively followed-up adverse clinical coronary events (MACE: cardiac death, CABG, acute coronary syndrome, congestive heart failure) and adverse angiographical coronary events (AGCE: newly stenosed or occluded coronary artery).
Results: For a mean follow-up period of 132 months (range; 120 to 144) with complete follow-up, the patients in the lower third with severe endothelial dysfunction (Group-L) more frequently developed MACE and AGCE than Group-M with mild endothelial dysfunction or Group-H with normal endothelial function (p<0.001, by Kaplan-Meier analyses), while the patients in Group-H less frequently developed MACE and AGCE than Group-M or Group-L (p<0.001). Cox hazard proportional model analyses indicated severe endothelial dysfunction determined by DATP was the strong predictor for MACE (hazard ratio=7.29, 95%confidential interval; 2.42–11.03, p<0.001) as well as for AGCE (hazard ratio=3.89, 95%confidential interval; 1.39 – 6.40, p=0.008).
Conclusion: This is the novel and longest follow-up study that demonstrates coronary endothelial dysfunction provides multiple adverse prognostic impacts on clinical as well as angiographical manifestation of adverse coronary events.