Abstract 11819: The Impact of Peripheral Artery Disease Assessed by Ankle-Brachial Index on Endothelial Dysfunction and Risk of In-Stent Restenosis After Percutaneous Coronary Intervention
Introduction: Although drug-eluting stent (DES) has been gradually replacing the bare-metal stent (BMS), the problem of in-stent restenosis (ISR) remains unresolved. Peripheral artery disease (PAD), defined as a decreased ankle-brachial index (ABI), is a risk factor for cardiovascular disease. However, to our knowledge, no studies have assessed the relationship between PAD and ISR after percutaneous coronary intervention (PCI).
Hypothesis: We assessed the hypothesis whether ABI at PCI could predict occurrence of ISR.
Methods: ABI and reactive hyperemia index (RHI) assessed by peripheral arterial tonometry were checked before PCI and at follow-up (F/U) angiography in 246 consecutive patients who had successful PCI. Patients were categorized according to their ABI values (PAD: ABI≦0.9, borderline: 0.9<ABI<1.0, normal: 1.0≦ABI). F/U angiography was performed at 6 and 9 months after PCI with BMS and DES, respectively. ISR was defined as percent diameter stenosis greater than 50% at F/U angiography.
Results: Within the study population, there were 30 PAD, 26 borderline, and 190 normal ABI at the index PCI. Among them, ISR was demonstrated in 68 patients (28%). As the ABI status become worse, patients were found to have significantly higher ISR rate (PAD: 47% (14/30), borderline: 35% (9/26), normal: 24% (45/190), p=0.02). Patients with PAD and borderline showed more impaired peripheral endothelial function assessed by RHI than normal (PAD: 1.57±0.44, borderline: 1.77±0.41, normal: 1.97±0.52, p=0.0001). Furthermore, patients with ISR had significantly lower ABI than those without (1.05±0.15 vs. 1.11±0.13, p=0.004). By multivariate logistic regression analysis even after adjusting for other significant parameters in univariate analysis (HDL-cholesterol, statin use, total stent length, post-PCI minimum lumen diameter, current smoking, and BMS use), PAD proved to be the independent predictor of ISR (Odds ratio 2.90; 95% confidence interval; 1.16 to 7.24, p=0.02).
Conclusions: In patients undergoing PCI, PAD is associated with a higher rate of subsequent ISR. Impaired endothelial function might explain this phenomenon. These findings have important implications for the careful F/U of PAD patients undergoing PCI as ISR-prone patients.
Author Disclosures: N. Komura: None. K. Tsujita: None. K. Yamanaga: None. K. Sakamoto: None. T. Miyazaki: None. N. Tabata: None. M. Ishii: None. T. Akasaka: None. Y. Arima: None. T. Ono: None. S. Kojima: None. S. Tayama: None. K. Kaikita: None. S. Hokimoto: None. K. Hibi: None. K. Kimura: None. S. Umemura: None. H. Ogawa: Other Research Support; Modest; AstraZeneca, Astellas, Boehringer lngelheim, Bristol-Myers Squibb, Daiichi Sankyo, Dainippon Sumitomo Pharma, Kowa, MSD, Novartis, Pfizer, Sanofi, Takeda. Other Research Support; Significant; Bayer, Chugai, Otsuka. Honoraria; Modest; AstraZeneca, Bayer, Pfizer, Sanofi, Takeda. Honoraria; Significant; Daiichi Sankyo, MSD.
- © 2014 by American Heart Association, Inc.