Abstract 14089: Persistent Impairment of Endothelial Vasomotor Function Adversely Affects Long-term Outcome in Patients with Acute Coronary Syndromes
Although endothelial vasomotor dysfunction represents an adverse outcome in patients with ischemic heart disease (IHD), it remains undefined whether reversibility of endothelial dysfunction after risk factor reduction provides prognostic information. This study assessed the hypothesis that changes in endothelial vasomotor function after optimized therapies for IHD may predict future outcomes in patients with acute coronary syndromes (ACS).
Methods: This study included 169 consecutive patients with newly diagnosed ACS who had an impairment of flow-mediated dilation of the brachial artery (FMD) at enrollment. All patients had individualized, optimized therapies including medications and recommended life style changes for IHD according to the AHA guidelines. Measurement of FMD (expressed as percent dilation from baseline artery diameter) was performed at entry (at discharge, 1st FMD) and 6 months (2nd FMD) after therapies were initiated. After the 2nd FMD, all patients continued their same medications and life style and were prospectively followed for 24 months or until the occurrence of one of the following cardiac events (cardiac death, nonfatal myocardial infarction, unstable angina requiring coronary revascularization, or worsening heart failure requiring hospitalization). The impairment of FMD was defined as < 5.5% (mean minus 1 SD of FMD in 100 age- and sex-matched normal subjects).
Results: FMD was persistently impaired (< 5.5%) at the 2nd FMD test in 81 (48%) patients, while it was improved (FMD ≥ 5.5%) in the remaining 88 (52%) patients. During the follow-up period, events occurred in 25 (31%) of the 81 patients with persistently impaired FMD and in 6 (7%) of the 88 patients with improved FMD (p < 0.001). Using multivariate Cox proportional hazards analysis, persistent impairment of FMD was a predictor of future events that was independent of 1st FMD, BNP levels, LVEF and other traditional risk factors (HR 3.4, 95%CI 1.5 – 7.2, p < 0.01). In contrast, 1st FMD had no significant predictive value.
Conclusions: Persistent impairment of endothelial function despite optimized therapies for IHD represents an adverse outcome in patients with ACS. Periodic measurement of FMD may be useful for risk stratification in ACS survivors.
- © 2010 by American Heart Association, Inc.