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Abstract
Background and Objectives
Endothelial dysfunction plays a key role in atherogenesis and it can predict future cardiovascular events in subjects with and without coronary artery disease. This study was designed to evaluate the association between endothelial dysfunction and major adverse cardiovascular events (MACEs), and especially future stroke in patients who have undergone percutaneous coronary intervention (PCI).
Subjects and Methods
The study subjects consisted of 182 patients (mean age; 59 years, 120 males) who underwent PCI and flow-mediated brachial arterial dilation (FMD) using high-resolution ultrasound. They were followed up for a mean of 28 months (maximum; 34 months). MACEs included cardiac death, non-cardiac death, acute myocardial infarction (AMI), stroke, coronary artery bypass graft (CABG), target lesion revascularization (TLR) and PCI due to de novo lesion during follow-up.
Results
The study subjects were divided into two groups according to the median value of the FMD; one was a patient with a high FMD (3.61% and the other was a patients with a low FMD<3.61%. There were 74 MACEs in 66 patients; 3 AMIs, 7 strokes, 49 TLRs, 2 CABGs and 13 de novo PCIs. FMD showed no significant differences between the patients with and without MACEs (3.9±2.3% vs. 4.1±2.1%, respectively, p>0.05). Univariate analysis showed that the patients with a lower FMD had a higher incidence of stroke (7 vs. 0, respectively, p=0.005) than those patients with a higher FMD, while there was no significant difference between the two groups in terms of AMI (1 vs. 2, respectively), TLR (28 vs. 21, respectively), de novo PCI (6 vs. 7, respectively), CABG (0 vs. 2, respectively) and cardiac death (0 vs. 0, respectively). On the multivariate Cox regression analysis, FMD was the strongest predictor of stroke (OR; 0.418, 95% CI; 0.185 to 0.940, p=0.035).
Figures and Tables
Fig. 1
Kaplan-Meier analysis of event-free survival curves according to the level of flow-mediated dilation (FMD). A: analysis for all major adverse cardiovascular events (MACE). B: analysis for stroke.
Table 1
Patients demographics according to the presence of MACE
*p<0.05 compared with group of with MACE. MACE: major adverse cardiovascular event, BMI: body mass index, HDL: high density lipoprotein, LDL: low density lipoprotein, Hs-CRP: high sensitivity-C reactive protein, LVEF: left ventricle ejection fraction, FMD: flow mediated dilation, AMI: acute myocardial infarction, MI: myocardial infarction, DS: diameter stenosis
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