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

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Hyperemia
Manometry
Arteries
Outcome Assessment (Health Care)
Percutaneous Coronary Intervention
Multivariate Analysis
Confidence Intervals
Cardiogenic Shock
ST Elevation Myocardial Infarction
Atrioventricular Block
Diabetes Mellitus
Cohort Studies
Myocardial Infarction
Prospective Studies

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

Cite this

@article{d39b29aa15eb4e14938842008dc12370,
title = "Endothelial Dysfunction After ST-segment Elevation Myocardial Infarction and Long-term Outcome: A Study With Reactive Hyperemia Peripheral Artery Tonometry",
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.",
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",
author = "Kandhai-Ragunath, {Jasveen J.} and Doggen, {Carine J.M.} and Jorstad, {Harald T.} and Cees Doelman and {de Wagenaar}, Bjorn and IJzerman, {Maarten J.} and Peters, {Ron J.G.} and {von Birgelen}, Clemens",
year = "2016",
month = "4",
day = "5",
doi = "10.1016/j.recesp.2015.12.020",
language = "English",
volume = "69",
pages = "664--671",
journal = "Revista Espanola de cardiologia (English edition)",
issn = "1885-5857",
publisher = "Elsevier Doyma",
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}

Endothelial Dysfunction After ST-segment Elevation Myocardial Infarction and Long-term Outcome : A Study With Reactive Hyperemia Peripheral Artery Tonometry. / Kandhai-Ragunath, Jasveen J.; Doggen, Carine J.M.; Jorstad, Harald T.; Doelman, Cees; de Wagenaar, Bjorn; IJzerman, Maarten J.; Peters, Ron J.G.; von Birgelen, Clemens.

In: Revista Espanola de cardiologia (English edition), Vol. 69, No. 7, 05.04.2016, p. 664-671.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Endothelial Dysfunction After ST-segment Elevation Myocardial Infarction and Long-term Outcome

T2 - A Study With Reactive Hyperemia Peripheral Artery Tonometry

AU - Kandhai-Ragunath, Jasveen J.

AU - Doggen, Carine J.M.

AU - Jorstad, Harald T.

AU - Doelman, Cees

AU - de Wagenaar, Bjorn

AU - IJzerman, Maarten J.

AU - Peters, Ron J.G.

AU - von Birgelen, Clemens

PY - 2016/4/5

Y1 - 2016/4/5

N2 - 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.

AB - 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.

KW - IR-100983

KW - METIS-316542

KW - Endothelial function (dysfunction)

KW - Reactive hyperemia peripheral artery tonometry

KW - Myocardial infarction

KW - ST-segment elevation myocardial infarction (STEMI)

KW - Primary percutaneous coronary intervention

KW - Coronary artery disease

U2 - 10.1016/j.recesp.2015.12.020

DO - 10.1016/j.recesp.2015.12.020

M3 - Article

VL - 69

SP - 664

EP - 671

JO - Revista Espanola de cardiologia (English edition)

JF - Revista Espanola de cardiologia (English edition)

SN - 1885-5857

IS - 7

ER -