Persistent Dysfunction of Coronary Endothelial Vasomotor Responses is Related to Atheroma Plaque Progression in the Infarct-Related Coronary Artery of AMI Survivors

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: ST-segment elevation myocardial infarction (STEMI) (n=50). Intervention: Persistent impairment of coronary endothelial vasomotor response to acetylcholine vs. No persistent impairment of coronary endothelial vasomotor response. Primary outcome: Progression of percent atheroma volume (PAV) over 6 months (OR 6.15, 95% CI 1.35-28.13, p=0.02).

Q: What does this research mean for the field?

Persistent impairment of coronary endothelial vasomotor function in response to acetylcholine is significantly associated with atheromatous plaque progression in the infarct-related coronary artery of STEMI survivors. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Takeo Horikoshi; Jun–ei Obata; Takamitsu Nakamura; Daisuke Fujioka; Yosuke Watanabe; Kazuto Nakamura; Kazuhiro Watanabe; Yukio Saitō; Kiyotaka Kugiyama

doi:10.5551/jat.48249

April 15, 2019Journal of Atherosclerosis and ThrombosisOpen Access

Persistent Dysfunction of Coronary Endothelial Vasomotor Responses is Related to Atheroma Plaque Progression in the Infarct-Related Coronary Artery of AMI Survivors

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Key result

Persistent coronary endothelial dysfunction is linked to a ~6-fold increase in plaque progression after STEMI.

OR 6.15
95% CI 1.35-28.13
P=0.02
n=50

Figures

Why the study?

Few human studies have examined the relationship between coronary endothelial vasomotor dysfunction and atheroma plaque progression in the same coronary artery after STEMI.

Study Design

Type

Cohort (n=50)

Multicenter

No

PICO

P

Population

50 patients under 80 years of age with a first acute STEMI due to LAD occlusion and successful reperfusion therapy with PCI, followed for 6 months.

E

Exposure / Comparator

Persistent impairment of coronary endothelial vasomotor response to acetylcholine vs No persistent impairment of coronary endothelial vasomotor response

O

Primary Outcome

Progression of percent atheroma volume (PAV) over 6 months — OR 6.15 (1.35-28.13), p=0.02

Main Result

Odds Ratio: 6.15 (95% CI 1.35–28.13)

p-value: p=0.02

Limitations

Excluded patients with residual organic stenosis (≥30%) or high constrictor response (≥30%) to ACh
Excluded patients with new lesions (≥30% stenosis) during follow-up
Risk-factor modification was not optimal for some patients
Cut-off value for impaired coronary vasomotor responses was arbitrarily determined from control subjects
Coronary segment analyzed for epicardial vasomotion by QCA was not necessarily identical to the segment analyzed by IVUS
Did not analyze the relationship of coronary vasomotor responses with coronary plaque composition
Approximately 20% of patients were excluded after the 1st test

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Implication

Persistent endothelial dysfunction may flag STEMI survivors for plaque progression risk; extends prior vasomotor-event links but leaves open therapeutic implications.

Abstract

AIM: Although coronary endothelial vasomotor dysfunction predicts future coronary events, there are few human studies showing the relationship between endothelial vasomotor dysfunction and atheroma plaque progression in the same coronary artery. This study examined whether endothelial vasomotor dysfunction is related to atheroma plaque progression in the infarct-related coronary artery of ST-segment elevation myocardial infarction (STEMI) survivors using serial assessment of coronary plaque size with intravascular ultrasound (IVUS) and coronary vasomotor responses to acetylcholine (ACh). METHODS: test) after AMI under optimal anti-atherosclerotic therapies. RESULTS: tests. PAV and TAV progression had no significant association with traditional risk factors, PCI-related variables, medications, and the coronary vasomotor responses to sodium nitroprusside, an endothelium-independent vasodilator. CONCLUSIONS: Persistent impairment of endothelial vasomotor function in the conduit arterial segment and the resistance arteriole was related to atheromatous plaque progression in the infarct-related coronary arteries of STEMI survivors.

Discussion

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Cite This Study

Horikoshi et al. (2019) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=50). Persistent impairment of coronary endothelial vasomotor response to acetylcholine vs. No persistent impairment of coronary endothelial vasomotor response was evaluated on Progression of percent atheroma volume (PAV) over 6 months (OR 6.15, 95% CI 1.35-28.13, p=0.02). Persistent impairment of epicardial coronary diameter response to acetylcholine was significantly associated with atheroma plaque progression in the infarct-related coronary artery of STEMI survivors (OR 6.15).

synapsesocial.com/papers/6ac1cc75530d2726b1b09fed https://doi.org/10.5551/jat.48249

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Persistent Dysfunction of Coronary Endothelial Vasomotor Responses is Related to Atheroma Plaque Progression in the Infarct-Related Coronary Artery of AMI Survivors

Figures

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Persistent Dysfunction of Coronary Endothelial Vasomotor Responses is Related to Atheroma Plaque Progression in the Infarct-Related Coronary Artery of AMI Survivors

Figures

Study Design

PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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