Abstract 18657: Impaired Peripheral Endothelial Function Assessed by Digital Reactive Hyperemia Peripheral Arterial Tonometry and Risk of In-Stent Restenosis
Introduction: Drug-eluting stents (DES) are replacing bare-metal stents (BMS), but in-stent restenosis (ISR) remains a problem. Impaired endothelial function is a key event in the atherosclerosis process and a predictor of future cardiovascular events. Reactive hyperemia index (RHI) assessed by peripheral arterial tonometry evaluates endothelial function noninvasively.
Hypothesis: We prospectively assessed the prognostic value of RHI in predicting ISR after percutaneous coronary intervention (PCI).
Methods: RHI was measured before PCI and at follow-up (F/U) angiography (6 and 9 months post BMS- and DES-PCI, respectively) in 249 consecutive patients. ISR was defined as >50% stenosis at F/U assessed by quantitative coronary angiography.
Results: ISR was seen in 68 patients (27.3%). F/U ln(RHI) was significantly lower in patients with ISR than in those without (0.52 ± 0.23 vs. 0.65 ± 0.27, p<0.01); no between-group difference in initial ln(RHI) was seen (0.60 ± 0.26 vs. 0.62 ± 0.25, p = 0.56). Absolute change in ln(RHI) was -0.15 ± 0.56 in the ISR group and 0.08 ± 0.57 in the non-ISR group (p<0.01). ISR occurred more frequently in the worsening-ln(RHI) group than in the improving-ln(RHI) group (43 of 122 [35%] vs. 25 of 127 [20%], p<0.01). By multivariate logistic regression analysis, F/U ln(RHI) independently predicted ISR (odds ratio: 0.13; 95% confidence interval [CI]: 0.04-0.48; p<0.01). Furthermore, in patients treated with DES only, ISR rate was 19.4% and RHI was also found to be a significant factor in predicting ISR by multiple logistic regression analysis (odds ratio 0.09; 95% CI: 0.02-0.49; p<0.01). In receiver operating-characteristic analysis, F/U RHI was the strongest predictor of ISR (area under the curve [AUC]: 0.67; 95% CI: 0.60-0.75; p<0.01; RHI < 1.73 had 67.6% sensitivity, 64.1% specificity); AUC significantly improved from 0.62 to 0.70 when RHI was added to traditional ISR risk factors (diabetes mellitus, total stent length, minimum stent diameter)(p=0.02). Net reclassification index was significant after addition of RHI (26.5%, p<0.01).
Conclusions: Impaired RHI at F/U angiography independently correlated with ISR, adding incremental prognostic value to ISR-risk stratification following PCI.
Author Disclosures: N. Komura: None. K. Tsujita: None. K. Yamanaga: None. K. Sakamoto: None. K. Kaikita: None. S. Iwashita: None. S. Sugiyama: None. K. Matsui: None. K. Hibi: None. T. Sugano: None. T. Ishikawa: None. K. Kimura: None. S. Hokimoto: None.
- © 2016 by American Heart Association, Inc.