Persistent Impairment of Endothelial Vasomotor Function Has a Negative Impact on Outcome in Patients With Coronary Artery Disease
Persistent Impairment of Endothelial Vasomotor Function Has a Negative Impact on Outcome in Patients With Coronary Artery Disease
复制标题
DOI：
10.1016/j.jacc.2008.08.074
复制
发表时间：
2009-01-27
影响因子：
24
通讯作者：
Kugiyama, Kiyotaka
中科院分区：
文献类型：
--
作者：
Kitta, Yoshinobu;Obata, Jyun-ei;Kugiyama, Kiyotaka
目的：我们评估了动脉粥样硬化性冠状动脉疾病最佳治疗后内皮血管功能的变化预测未来心血管事件的假设。目前尚不清楚内皮功能障碍对危险因素减少的可逆性是否提供了预后信息。诊断为冠状动脉疾病和肱动脉血流介导的扩张（FMD）受损（FMD < 5.5%）。根据美国心脏病学会/美国心脏协会指南，6个月后重复测量FMD，以进行个性化和优化治疗，以减少风险因素。患者随访36个月或直至发生以下事件之一：心源性死亡、非致死性心肌梗死、需要冠状动脉血运重建的复发性和难治性心绞痛或缺血性卒中优化治疗6个月后，104例（41%）患者的FMD改善（< 5.5%），而其余147例（59%）患者的FMD改善（≥ 5.5%）。在36个月的随访中，27例（26%）FMD持续受损的患者和15例（10%）FMD改善的患者发生了事件（卡方检验p < 0.01）。多变量考克斯风险分析显示，FMD的持续损害是事件的独立预测因子（风险比：2.9，95%置信区间：1.5至6.2，p < 0.01）。基线FMD优化治疗前，以减少危险因素没有显着的预后informations.Conclusions持续损害的内皮血管功能，尽管优化治疗，以减少危险因素对冠心病患者的结果产生不利影响。（美国科尔心脏病学杂志2009; 53：323-30）（C）2009年美国心脏病学会基金会
Objectives We assessed the hypothesis that changes in endothelial vasomotor function in response to optimized therapy for atherosclerotic coronary artery disease predict future cardiovascular events.Background Although endothelial vasomotor dysfunction is a predictor of cardiovascular events, it remains unclear whether reversibility of endothelial dysfunction in response to risk factor reduction provides prognostic information.Methods This study included 251 patients with newly diagnosed coronary artery disease and an impaired flow-mediated dilation (FMD) of the brachial artery (FMD < 5.5%). Measurement of FMD was repeated after 6 months for individualized and optimized therapy to reduce risk factors according to American College of Cardiology/American Heart Association guidelines. Patients were followed up for 36 months or until 1 of the following events occurred: cardiac death, nonfatal myocardial infarction, recurrent and refractory angina pectoris requiring coronary revascularization, or ischemic stroke.Results FMD was persistently impaired (< 5.5%) in 104 (41%) patients after 6 months of optimized therapy, whereas it improved (FMD >= 5.5%) in the remaining 147 (59%) patients. During 36 months of follow-up, events occurred in 27 (26%) patients with persistently impaired FMD and in 15 (10%) patients with improved FMD (p < 0.01 by chi-square test). Multivariate Cox hazards analysis showed that persistent impairment of FMD was an independent predictor of events (hazard ratio: 2.9, 95% confidence interval: 1.5 to 6.2, p < 0.01). Baseline FMD before the optimized therapy to reduce risk factor had no significant prognostic information.Conclusions Persistent impairment of endothelial vasomotor function despite optimized therapy to reduce risk factors has an adverse impact on outcome in coronary artery disease patients. (J Am Coll Cardiol 2009; 53: 323-30) (C) 2009 by the American College of Cardiology Foundation