Introduction:
Percutaneous coronary intervention (PCI) is performed in patients with coronary heart disease to improve symptoms and clinical prognosis. Despite optimal therapies after PCI, some patients experience one or more adverse outcome. Therefore, to evaluate the determinants of the residual risk of cardiovascular events is still important. Endothelial dysfunction has been reported to correlate with adverse cardiovascular events in coronary heart disease.
Hypothesis:
We hypothesized that endothelial dysfunction could predict future cardiovascular events in patients following coronary stent implantation.
Methods:
We conducted a prospective cohort study of 435 patients after coronary stent implantation. All patients received aspirin and clopidogrel in addition to other optimal medications. Peripheral endothelial dysfunction was expressed as reactive hyperemia index (RHI) using reactive hyperemia peripheral arterial tonometry, and we used the median value of the RHI (0.54) to divide patients into low (n=218, male 70.2%) and high (n=217, male 70%) RHI groups. We followed cardiovascular events after coronary stent implantation.
Results:
There was no significant difference in clinical characteristics between the low and high group. A total of 64 patients had a cardiovascular event. The incidence of cardiovascular event was significantly higher in the low RHI group (20.2% versus 9.2%; P=0.007). Kaplan-Meier analysis demonstrated a significantly higher probability of cardiovascular events in the low RHI group than in the high RHI group (mean follow-up: 70 months; log-rank test: P=0.002). Multivariate Cox hazard analysis among various clinical factors demonstrated that body mass index (hazard ratio [HR]: 0.906; 95% confidence interval [CI]: 0.838 to 0.980; P=0.014), peripheral arterial disease (HR: 1.834; 95% CI: 1.003 to 3.351; P=0.049), Cytochrome P450 loss-of-function allele carriage (HR: 2.005; 95% CI: 1.101 to 3.651; P=0.023), and RHI (HR: 0.149; 95% CI: 0.044 to 0.502; P=0.002) as independent and significant determinants of clinical outcome.
Conclusions:
Peripheral endothelial dysfunction independently correlated with future cardiovascular events in patients following coronary stent implantation.
Patients with both CYP2C19 loss-of-function allele and peripheral endothelial dysfunction are significantly correlated with adverse cardiovascular events following coronary stent implantation
