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Peripheral Artery Tonometry Reveals Impaired Endothelial Function before Percutaneous Coronary Intervention in

Zhangwei Chen1, You Zhou2, Jiasheng Yin1

  • 1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China.

Journal of Interventional Cardiology
|August 6, 2021
PubMed
Abstract

Insights

Reactive hyperemia index (RHI) measured by peripheral artery tonometry (PAT) can predict periprocedural myocardial injury (PMI) before coronary interventions. Lower RHI also indicates a higher risk of adverse cardiac events after drug-eluting stent implantation.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Periprocedural myocardial injury (PMI) is a common complication following percutaneous coronary intervention (PCI).
  • Coronary microvascular dysfunction (CMD) and PMI are interrelated, potentially influenced by microembolization and inflammation.
  • Reactive hyperemia index (RHI) via peripheral artery tonometry (PAT) offers a noninvasive assessment of endothelial function and CMD, showing potential for PMI prediction.

Purpose of the Study:

  • To evaluate the predictive value of RHI for periprocedural myocardial injury (PMI) in patients undergoing coronary angiography.
  • To assess the association between RHI, PMI, and long-term cardiovascular outcomes after percutaneous coronary intervention (PCI).

Main Methods:

  • 268 patients with suspected stable coronary artery disease (CAD) scheduled for elective coronary angiography were enrolled.
  • Reactive hyperemia index (RHI) was measured using the Endo-PAT2000™ device prior to angiography.
  • The correlation between RHI, PMI, and subsequent cardiovascular events was analyzed.

Main Results:

  • Patients with CAD exhibited lower RHI compared to those without (1.88 ± 0.55 vs. 2.02 ± 0.58, P < 0.05).
  • Patients who developed PMI had significantly lower pre-angiography RHI (1.75 ± 0.37 vs. 1.95 ± 0.50, P < 0.05).
  • RHI demonstrated moderate predictive capability for PMI (AUC 0.61) and identified CAD patients with RHI ≤ 1.81 at higher risk for composite cardiac events post-stenting (aHR 3.31).

Conclusions:

  • RHI assessment using PAT is a promising noninvasive tool for predicting PMI before PCI.
  • A lower RHI is associated with an elevated risk of long-term adverse cardiac events, particularly after drug-eluting stent implantation.

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