Endothelial Dysfunction After ST-segment Elevation Myocardial Infarction and Long-term Outcome: A Study With Reactive Hyperemia Peripheral Artery Tonometry

Jasveen J. Kandhai-Ragunath, Carine J.M. Doggen, Harald T. Jorstad, Cees Doelman, Bjorn de Wagenaar, Maarten J. IJzerman, Ron J.G. Peters, Clemens von Birgelen

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Abstract

Introduction and objectives: Long-term data on the relationship between endothelial dysfunction after ST-segment elevation myocardial infarction and future adverse clinical events are scarce. The aim of this study was to noninvasively assess whether endothelial dysfunction 4 to 6 weeks after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction predicts future clinical events.

Methods: This prospective cohort study was performed in 70 patients of the RESPONSE randomized trial, who underwent noninvasive assessment of endothelial function 4 to 6 weeks after primary percutaneous coronary intervention. Endothelial function was measured by the reactive hyperemia peripheral artery tonometry method; an index < 1.67 identified endothelial dysfunction.

Results: The reactive hyperemia peripheral artery tonometry index measured on average 1.90 ± 0.58. A total of 35 (50%) patients had endothelial dysfunction and 35 (50%) patients had normal endothelial function. Periprocedural “complications” (eg, cardiogenic shock, total atrioventricular block) were more common in patients with endothelial dysfunction than in those without (25.7% vs 2.9%; P < .01). During 4.0 ± 1.7 years of follow-up, 20 (28.6%) patients had major adverse cardiovascular events: events occurred in 9 (25.7%) patients with endothelial dysfunction and in 11 (31.5%) patients with normal endothelial function (P = .52). There was an association between the prevalence of diabetes mellitus at baseline and the occurrence of major adverse cardiovascular events during follow-up (univariate analysis: hazard ratio = 2.8; 95% confidence interval, 1.0-7.8; P < .05), and even in multivariate analyses the risk appeared to be increased, although not significantly (multivariate analysis: hazard ratio = 2.5; 95% confidence interval, 0.8-7.5).

Conclusions: In this series of patients who survived an ST-segment elevation myocardial infarction, endothelial dysfunction, as assessed by reactive hyperemia peripheral artery tonometry 4 to 6 weeks after myocardial infarction, did not predict future clinical events during a mean follow-up of 4 years.

Original languageEnglish
Pages (from-to)664-671
Number of pages11
JournalRevista Espanola de cardiologia (English edition)
Volume69
Issue number7
DOIs
Publication statusPublished - 5 Apr 2016

Keywords

  • IR-100983
  • METIS-316542
  • Endothelial function (dysfunction)
  • Reactive hyperemia peripheral artery tonometry
  • Myocardial infarction
  • ST-segment elevation myocardial infarction (STEMI)
  • Primary percutaneous coronary intervention
  • Coronary artery disease

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