Abstract 20713: Coronary Endothelial Function Predicts Long Term Cardiovascular Outcomes
Background: Endothelial function is associated with most cardiovascular (CV) risk factors and its measurements may aid in future prediction of CV events. We investigated the utility of coronary microvascular endothelial function and coronary epicardial endothelial function in predicting CV events in subjects without coronary heart disease.
Methods: Follow-up was obtained in 502 patients with mildly diseased coronary arteries who had undergone coronary vascular reactivity evaluation by graded infusion of intracoronary Acetylcholine (ACh). After maximal dose of ACh microvascular endothelial function was measured by percent change of coronary blood flow (% Δ CBF) and epicardial endothelial function was measured by percent changes of coronary artery diameter (% Δ CAD) from baseline. Patient characteristics and CV risk factors were obtained at baseline. A multiple Cox proportional hazards model was used to assess the partial prognostic information between the coronary endothelial function and composite endpoint of major adverse cardiovascular events (MACE).
Results: During a 7-year follow-up (inter-quartile range = 4.5–12.5) MACE occurred in 57 patients (11%). In univariate analysis only presence of hyperlipidemia (HR 2.42; P=0.002) and % Δ CAD (HR 0.88 for 10% increase; P=0.039) were significant predicators of MACE. In multivariate analysis advancing age (HR 1.21 for 10 year increase; P=0.038), presence of hyperlipidemia (HR 2.73; P=0.002) and % Δ CBF (HR 0.97 for 10% increase; P=0.044) were identified as independent predicator of MACE. Other traditional Framingham risk factors were not associated with MACE.
Conclusion: Endothelial dysfunction is an independent predictor of adverse CV outcome in patients without obstructive coronary artery disease and may provide a better predictive value of future CV events than some of the traditional risk factors.
- Endothelial function
- Coronary microcirculation
- Risk factors
- Myocardial revascularization
- Myocardial infarction
- © 2010 by American Heart Association, Inc.