Reduced systemic endothelium-dependent vasoreactivity to acetylcholine independently predicted cardiovascular death, myocardial infarction, and ischemic stroke in patients with acute coronary syndromes (P<0.05).
Cohort (n=198)
Does systemic endothelial dysfunction predict cardiovascular events in patients with acute coronary syndromes?
Systemic endothelium-dependent vasoreactivity, measured by a minimally invasive test, is an independent predictor of recurrent cardiovascular events in patients with acute coronary syndromes.
p-value: p=<0.05
BACKGROUND: Endothelial vasodilator dysfunction may serve as a marker integrating the vascular risk of an individual; however, whether systemic vasodilator function predicts disease progression and cardiovascular event rates in patients with manifest acute coronary syndromes (ACS) is unknown. METHODS AND RESULTS: In 198 patients with angiographically documented ACS, forearm blood flow (FBF) responses to acetylcholine (ACH; 10 to 50 microg/min) and sodium nitroprusside (SNP; 2 to 8 microg/min) were measured by venous occlusion plethysmography before hospital discharge within 5 days of an episode of an ACS. Cardiovascular events (cardiovascular death, myocardial infarction, and ischemic stroke) served as outcome variables over a mean follow-up period of 47.7+/-15.1 months. Patients who experienced cardiovascular events during follow-up (n=31) had a significantly reduced vasodilator response to ACH (P<0.05) and SNP (P<0.05). By multivariate analysis, vasodilator response to ACH and elevated troponin T serum levels were the only significant (P<0.05) independent predictors of a poor prognosis, even after adjustment for traditional cardiovascular risk factors, concurrent medication, invasive treatment strategy, and C-reactive protein serum levels. Recovery of endothelium-dependent vasoreactivity as assessed by repeated FBF assessment 8 weeks after the index measurement after the ACS predicted further event-free survival in a subset of 78 patients. CONCLUSIONS: Systemic endothelium-dependent vasoreactivity predicts recurrence of instability and cardiovascular event rates in patients with ACS. Furthermore, the recovery of systemic endothelial function is associated with event-free survival. Assessment of systemic vasoreactivity, measured by a minimally invasive test, provides important prognostic information in addition to that derived from traditional risk factor assessment in patients with ACS.
Fichtlscherer et al. (Tue,) conducted a cohort in Acute Coronary Syndromes (n=198). Forearm blood flow response assessment (acetylcholine and sodium nitroprusside) was evaluated on Cardiovascular events (cardiovascular death, myocardial infarction, and ischemic stroke) (p=<0.05). Reduced systemic endothelium-dependent vasoreactivity to acetylcholine independently predicted cardiovascular death, myocardial infarction, and ischemic stroke in patients with acute coronary syndromes (P<0.05).