Abstract 17172: The Impact of Endothelial Function in Patients Who Achieved to an Ideal Therapeutic Goal With Intensive Optimal Medical Therapy After Complete Coronary Revascularization
Background: COURAGE trial demonstrated the importance of intensive optimalmedical therapy (OMT) in patients with coronary artery disease (CAD). All patients do not always achieve to ideal risk-factor reduction despite of contemporary medical treatment. We hypothesized that it may be different in future cardiac events between achieved OMT and non-achieved OMT patients. Therefore, we prospectively investigated endothelial function in CAD patients who underwent coronary intervention and contemporary medical therapy.
Method: We studied 83 consecutive patients (age 67±10 years, 82% male). Endothelial function was assessed <12 hours before coronary angiogram and at 3-month follow-up by measuring right brachial artery dilatation after 5 minutes of forearm ischemia flow mediated dilatation (FMD). We defined as achieved OMT group if patients achieved to following criteria; the blood pressure goal was ≦130/85 mmHg. The low-density lipoprotein (LDL) cholesterol was ≦85 mg/dl. A fasting blood glucose level of 80 to 125 mg/dl and a hemoglobin A1c level <7.0% was the goal for diabetes control. Primary endpoint was improvement of FMD.
Result: The proportion of coronary risk factors was as follows; (Hypertension 85%, dyslipidemia 85%, current smoker 31%, diabetes 61%). Contemporary medical therapy was used as follows; (statins 83%, antihypertensive agents 86%, antidiabetic agents 28 %). After 3 month following coronary intervention, achieved OMT group was 44 patients (53%), whereas 39 patients (47%) were non-achieved OMT group. Overall, the endothelial function with FMD improved from 8.0% to 11% during 3 months. However, endothelial function significantly improved in achieved OMT group. On the other hand, the change of FMD was not almost seen in non-achieved OMT group (figure).
Conclusion: This study showed the achievement to ideal risk-factor reduction with OMT was significantly associated with an improvement of endothelial function.
- © 2013 by American Heart Association, Inc.