Abstract 17273: Endothelial Function Predicts 1-year Adverse Clinical Outcome in Patients Hospitalized in Chest Pain Unit
Introduction: Endothelial dysfunction is a systemic disorder and a key variable in the pathogenesis of atherosclerosis and its complications.
Methods: To test the hypothesis that abnormal endothelial function is associated with adverse long-term outcome in patients presenting to the emergency department chest pain unit (CPU), we assessed endothelial function non-invasively, using peripheral arterial tonometry (EndoPAT, Itamar Medical, Israel) in 301 consecutive subjects with no history of coronary artery disease (CAD). Following the EndoPAT testing, patients underwent coronary computerized tomography angiography (CTA) or single-photon emission computed tomography (SPECT) according to availability. CPU physicians and patients were blinded to the EndoPAT results until the end of the study. Patients were followed-up telephonically after 6 and 12 months for combined major adverse cardiovascular end-points (MACE), including all-cause mortality, non-fatal myocardial infarction, hospitalization for heart failure or angina pectoris, stroke, coronary artery bypass grafting and percutaneous coronary interventions.
Results: Study cohort included 301 patients, mean age 50±10 years, 83% males, mean 10-year Framingham risk score (FRS) 6.6±6.0%. Median reactive hyperemia index (RHI) as a measure of endothelial function was 2.08 and mean was 2.0±0.5. During a 1-year follow-up, the 20 (6.6%) patients who developed MACE were more diabetic (28% vs 11%, p=0.01), had higher 10-year FRS (10.2±7.9% vs 6.3±5.7%; p=0.024), higher resting heart rate (72±13 vs 67±1, p<0.05), lower baseline RHI (1.5±0.4 vs 2.1±0.4; p<0.001) and a greater extent of coronary atherosclerosis lesions (56% vs 4%, p<0.001) in the CPU CTA, compared to those without SAEs. RHI ≤ the median was associated with higher 1-year MACE (12.6% vs 0.7%, p<0.001) compared to RHI > the median. Multivariate analysis demonstrated that RHI ≤ the median is an independent predictor of coronary atherosclerosis lesions in the CPU CTA (OR 5.98, 95% CI 03.29-10.88; p<0.001) and 1-year MACE (OR 12.5, 95% CI 1.49-106.0; p<0.001).
Conclusions: Our findings suggest that non-invasive endothelial function testing may have clinical utility in triaging patients in the CPU and in predicting 1-year MACE.
Author Disclosures: M. Shechter: Consultant/Advisory Board; Modest; Itamar Medical, Inc.. S. Matetzky: None. M. Prasad: None. N. Koren-Morag: None. A. Lerman: Consultant/Advisory Board; Modest; Itamar Medical, Inc..
- © 2016 by American Heart Association, Inc.