Abstract 11400: Impaired Peripheral Endothelial Function as Assessed by Digital Reactive Hyperemia Peripheral Arterial Tonometry and Risk of In-Stent Restenosis
Introduction: Although drug-eluting stent (DES) has been gradually replacing the bare-metal stent (BMS), the problem of in-stent restenosis (ISR) remains unresolved. Impaired endothelial function is a key event in the atherosclerosis process and a predictor of future cardiovascular events. Fingertip reactive hyperemia peripheral arterial tonometry (RH-PAT) is a new device that provides noninvasive, automatic, and quantitative evaluation of endothelial dysfunction with low intra- and inter-observer variability.
Hypothesis: We assessed the hypothesis that whether reactive hyperemia index (RHI) as a marker of endothelial dysfunction could predict occurrence of ISR after percutaneous coronary intervention (PCI).
Methods: RHI was measured using Endo-PAT2000 (Itamar Medical, Caesarea, Israel) before PCI (initial RHI) and at follow-up angiography (F/U RHI) in 97 consecutive patients who had successful PCI in de novo coronary lesions. F/U angiography was performed at six and nine months after PCI with BMS and DES, respectively. ISR was defined as percent diameter stenosis >50% at F/U angiography assessed by quantitative coronary angiography.
Results: ISR was demonstrated in 23 patients (24%), whereas 74 patients (76%) remain free from ISR. Patients with ISR were found to have significantly lower F/U RHI than those without ISR (1.70±0.44 vs. 2.02±0.59, p=0.02), whereas initial RHI shows no significant difference. By multivariate logistic regression analysis, even after adjusting for other significant parameters in univariate analysis (HbA1c, HDL-Cholesterol, total stent length, BMS use), F/U RHI proved to be the independent predictor of ISR (Odds ratio 5.03; 95% confidence interval; 1.23 to 20.00, p=0.02). In receiver-operating characteristic analysis, F/U RHI was a strongest predictor of ISR (area under the curve 0.71; 95% confidence interval; 0.59 to 0.84, p=0.02; RHI of <1.73 had 69.6% sensitivity and 62.2% specificity).
Conclusions: This is the first study indicating that impaired RHI at the F/U angiography independently predicts occurrence of ISR. The simple and noninvasive assessment of endothelial function by RH-PAT at F/U period might be a useful screening tool to stratify patients who require further angiographic evaluation for ISR.
- © 2013 by American Heart Association, Inc.