Endothelial dysfunction as predictor of angina recurrence after successful percutaneous coronary intervention using second generation drug eluting stents. (29th August 2020)

• Record Type: Journal Article
• Authors: Montone, Rocco A; Niccoli, Giampaolo; Vergni, Federico; Vetrugno, Vincenzo; Russo, Michele; Mangiacapra, Fabio; Fracassi, Francesco; Porto, Italo; Leone, Antonio M; Burzotta, Francesco; D'Amario, Domenico; Aurigemma, Cristina; Trani, Carlo; Lanza, Gaetano A; Crea, Filippo
• Is Part Of: European journal of preventive cardiology. Volume 25:Number 13(2018)
• Page Start: 1360
• Page End: 1370
• Publication Date: 2020-08-29
• Subjects: Endothelial dysfunction -- PCI -- recurrent angina; Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiac patients -- Rehabilitation -- Periodicals; 616.12
• DOI: 10.1177/2047487318777435
• Languages: English
• ISSNs: 2047-4873

Abstract

Abstract: Background: The role of endothelial dysfunction in predicting angina recurrence after percutaneous coronary intervention is unknown. Design: We assessed the role of peripheral endothelial dysfunction measured by reactive-hyperaemia peripheral-artery tonometry (RH-PAT) in predicting recurrence of angina after percutaneous coronary intervention. Methods: We enrolled consecutive patients undergoing percutaneous coronary intervention with second-generation drug-eluting stents. RH-PAT was measured at discharge. The endpoint was repeated coronary angiography for angina recurrence and/or evidence of myocardial ischaemia at follow-up. Patients with in-stent restenosis and/or significant de novo stenosis were defined as having angina with obstructed coronary arteries (AOCA); all other patients as having angina with non-obstructed coronary arteries (ANOCA). Results: Among 100 patients (mean age 66.7 ± 10.4 years, 80 (80.0%) male, median follow-up 16 (3–20) months), AOCA occurred in 14 patients (14%), ANOCA in nine patients (9%). Repeated coronary angiography occurred more frequently among patients in the lower RH-PAT index tertile compared with middle and upper tertiles (14 (41.2%) vs . 6 (18.2%) vs . 3 (9.1%), p = 0.006, respectively). ANOCA was more frequent in the lower RH-PAT index tertile compared with middle and upper tertiles. In the multivariate regression analysis, the RH-PAT index only predicted angina recurrence. The receiver operating characteristic curve of the RH-PAT index to predict the angina recurrence demonstrated an area under the curve of 0.79 (95% confidence interval: 0.69–0.89; p < 0.001), with a cut-off value of 1.705, having sensitivity 74% and specificity 70%. Conclusions: Non-invasive assessment of peripheral endothelial dysfunction using RH-PAT might help in the prediction of recurrent angina after percutaneous coronary intervention, thus identifying patients who may need more intense pharmacological treatment and risk factor control.