Clinical Correlates and Prognostic Value of Flow Mediated Dilation in Patients With Non-ST Segment Elevation Acute Coronary Syndromes

被引：31
作者：
Careri, Giulia [1 ]
Nerla, Roberto [1 ]
Di Monaco, Antonio [1 ]
Russo, Giulio [1 ]
Stazi, Alessandra [1 ]
Villano, Angelo [1 ]
Sestito, Alfonso [1 ]
Lanza, Gaetano A. [1 ]
Crea, Filippo [1 ]
机构：
[1] Univ Cattolica Sacro Cuore, Dipartimento Med Cardiovasc, Rome, Italy
来源：
AMERICAN JOURNAL OF CARDIOLOGY | 2013年 / 111卷 / 01期
关键词：
C-REACTIVE PROTEIN; INCIDENT CARDIOVASCULAR EVENTS; ENDOTHELIAL FUNCTION; BRACHIAL-ARTERY; ATHEROSCLEROSIS; DYSFUNCTION; RISK;
D O I：
10.1016/j.amjcard.2012.08.049
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Endothelial dysfunction can predict cardiovascular outcomes in several populations of patients. The aim of this study was to assess the severity, time course, and clinical implications of endothelial dysfunction in patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS). Sixty patients with NSTE ACS (mean age 62 +/- 8 years, 44 men) and 40 controls with stable coronary artery disease (CAD) (mean age 63 +/- 10 years, 27 men) were studied. In patients with NSTE ACS and in those with stable CAD, endothelial function was assessed < 12 hours after admission and at 3-month follow-up by measuring right brachial artery dilation after 5 minutes of forearm ischemia (flow-mediated dilation [FMD]). Clinical outcomes were assessed after a median follow-up period of 32 months (range 14 to 36). The primary end point was a combination of cardiac death or readmission for new ACS or recurrence of angina pectoris. FMD on admission was significantly lower in patients with NSTE ACS compared to those with stable CAD (2.1 +/- 1.2% vs 4.8 +/- 1.9%, p < 0.001). FMD improved significantly at 3-month follow-up in patients, with NSTE ACS, becoming comparable to that in patients with stable CAD (5.7 +/- 2.6% vs 5.5 +/- 1.7%, p = 0.93). During follow-up, 14 cardiac events (23%) occurred in patients with NSTE ACS. On multivariate analysis, only diabetes (hazard ratio 18.1, 95% confidence interval 3.9 to 83.9, p < 0.001) and FMD at 3 months (hazard ratio 0.78, 95% confidence interval 0.61 to 0.99, p = 0.04) were independent predictors of the primary end point in patients with NSTE ACS. In conclusion, endothelial function is markedly impaired in the acute phase of NSTE ACS but improves significantly at 3-month follow-up. In patients with NSTE ACS, FMD at 3 months after the acute event is a significant independent predictor of cardiac outcomes. (c) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:51-57)
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页码：51 / 57
页数：7
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