Fichtlscherer, Stephan;
Breuer, Susanne;
Zeiher, Andreas M.
Prognostic Value of Systemic Endothelial Dysfunction in Patients With Acute Coronary Syndromes : Further Evidence for the Existence of the “Vulnerable” Patient
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Media type:
E-Article
Title:
Prognostic Value of Systemic Endothelial Dysfunction in Patients With Acute Coronary Syndromes : Further Evidence for the Existence of the “Vulnerable” Patient
:
Further Evidence for the Existence of the “Vulnerable” Patient
Contributor:
Fichtlscherer, Stephan;
Breuer, Susanne;
Zeiher, Andreas M.
Description:
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<jats:italic>Background—</jats:italic>
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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.
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<jats:italic>Methods and Results—</jats:italic>
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In 198 patients with angiographically documented ACS, forearm blood flow (FBF) responses to acetylcholine (ACH; 10 to 50 μg/min) and sodium nitroprusside (SNP; 2 to 8 μg/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 (
<jats:italic>P</jats:italic>
<0.05) and SNP (
<jats:italic>P</jats:italic>
<0.05). By multivariate analysis, vasodilator response to ACH and elevated troponin T serum levels were the only significant (
<jats:italic>P</jats:italic>
<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.
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<jats:bold>
<jats:italic>Conclusions—</jats:italic>
</jats:bold>
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.
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