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Published on: March 15, 2022
Endothelial function as predictor in patients with coronary syndrome treated by percutaneous coronary intervention
Xiaofeng Cheng1,2, Yun He1,2, Huaping Fan1,2
1Institute of Cardiovascular Diseases of PLA, Chongqing 400038, China.
Insights
Endothelial dysfunction, measured by reactive hyperemia-peripheral arterial tonometry (RH-PAT) index (RHI), predicts major cardiovascular events (MACEs) in acute coronary syndrome (ACS) patients post-percutaneous coronary intervention (PCI). RHI serves as a valuable biomarker for risk stratification.
Area of Science:
- Cardiovascular Medicine
- Clinical Cardiology
- Biomarker Research
Background:
- Endothelial dysfunction is a key factor in cardiovascular disease progression.
- Assessing endothelial function may aid in predicting outcomes for acute coronary syndrome (ACS) patients.
- Percutaneous coronary intervention (PCI) is a common treatment for ACS, but residual risk remains.
Purpose of the Study:
- To determine if the reactive hyperemia-peripheral arterial tonometry (RH-PAT) index (RHI) predicts future major cardiovascular events (MACEs).
- To evaluate the predictive role of RHI in ACS patients undergoing PCI.
- To assess RHI as a potential biomarker for risk stratification in this patient group.
Main Methods:
- RHI was measured in 308 ACS patients treated with PCI.
- Patients were categorized into normal endothelial function (NEF) and endothelial dysfunction (DEF) groups based on RHI.
- Follow-up for a mean of 16 months recorded MACEs; Kaplan-Meier and Cox hazard analyses were performed.
Main Results:
- The incidence of MACEs was significantly higher in the DEF group (25.39%) compared to the NEF group (15.96%) (P<0.05).
- Kaplan-Meier analysis showed a significantly higher MACE probability in the DEF group.
- Multivariate analysis identified RHI (HR: 0.425) and SYNTAX score (HR: 1.043) as independent predictors of MACEs post-PCI.
Conclusions:
- Endothelial function, assessed by RH-PAT index (RHI), is impaired in ACS patients treated with PCI.
- The RHI is an independent predictor of future MACEs in ACS patients after PCI.
- RHI shows potential as a useful biomarker for risk stratification in ACS patients undergoing PCI.
Abstract:
We aimed at identifying the predictive role of endothelial function assessed by the RH-PAT index (RHI) for future major cardiovascular events (MACEs) in acute coronary syndrome (ACS) patients treated with percutaneous coronary intervention (PCI). We measured RHI in 308 subjects with ACS, and they were divided into the normal endothelial function (NEF) group and the endothelial dysfunction (DEF) group according to the RHI. The subjects were followed up for a mean of 16 months (interquartile range [IQR]: 14-20 months) after PCI treatment, and their MACEs were also recorded. Cumulative incidence curves were constructed for time-to-event variables with Kaplan-Meier estimates and compared using the log-rank test. The overall incidence of MACEs was 25.39% in the DEF group and 15.96% in the NEF group (P<0.05). Kaplan-Meier analysis also demonstrated a significantly higher probability of MACEs in the DEF group than in the NEF group (log-rank test: P<0.05). Multivariate Cox hazard analysis identified RHI (Model 2, adjusted by blood pressure, hazard ratio [HR]: 0.425; 95% confidence interval [CI]: 0.198-0.914; P=0.029) and SYNTAX score (HR: 1.043; 95% CI: 1.019-1.067; P<0.001) as independent predictors of future MACEs after PCI treatment in ACS patients. Endothelial function measured by reactive hyperemia-peripheral arterial tonometry (RH-PAT) is impaired in ACS subjects treated with PCI. The RHI was an independent predictor of MACEs, suggesting that RHI may be useful as a candidate biomarker in the risk stratification of patients with ACS after PCI treatment.
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