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Published on: October 22, 2014
Endothelial dysfunction predicts bleeding and cardiovascular death in acute coronary syndrome
Tomohiro Yoshii1, Yasushi Matsuzawa2, So Kato2
1Division of Cardiology, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, Japan; National Cerebral and Cardiovascular Center, 6-1 Kishibe Shinmachi, Suita, Osaka, Japan.
Insights
Endothelial dysfunction increases risks for major bleeding and adverse cardiovascular events in acute coronary syndrome patients. This condition predicts future major bleeding and cardiovascular death, highlighting its clinical significance.
Area of Science:
- Cardiology
- Vascular Biology
- Clinical Research
Background:
- Growing recognition of bleeding as a predictor of adverse outcomes.
- Endothelial dysfunction is linked to increased cardiovascular and bleeding event risks.
- Need to understand endothelial dysfunction's role in acute coronary syndrome (ACS) complications.
Purpose of the Study:
- To investigate the association between endothelial dysfunction and major bleeding.
- To examine the link between endothelial dysfunction and specific causes of death.
- To assess endothelial dysfunction's relationship with major adverse cardiovascular events (MACE) in ACS patients.
Main Methods:
- Single-centre retrospective observational study of 674 ACS patients (June 2010-Nov 2014).
- Endothelial dysfunction defined as reactive hyperemia index <1.67, assessed before discharge.
- Median follow-up of 6.1 years; outcomes included major bleeding, all-cause death, cardiovascular death, and MACE.
Main Results:
- 39.2% of ACS patients (264/674) exhibited endothelial dysfunction.
- Endothelial dysfunction independently predicted major bleeding (HR 2.29) and MACE (HR 2.04).
- Patients with endothelial dysfunction had a 2.5-fold higher risk of cardiovascular death, but no link to non-cardiovascular death.
Conclusions:
- Endothelial dysfunction is a significant predictor of major bleeding in ACS patients.
- Reactive hyperemia index assessment of endothelial dysfunction predicts MACE and cardiovascular death.
- Findings underscore the importance of addressing endothelial dysfunction in ACS management.
Backgrounds:
Recently, there has been increasing awareness that bleeding may lead to adverse outcomes. Endothelial dysfunction is associated with increased risk of cardiovascular and bleeding events. This study aimed to investigate the association of endothelial dysfunction with major bleeding and specific causes of death in addition to major adverse cardiovascular events in patients with acute coronary syndrome.
Methods:
This single-centre retrospective observational study was conducted at a tertiary-care hospital; patients with acute coronary syndrome were included between June 2010 and November 2014 (median follow-up, 6.1 years). The reactive hyperaemia index was assessed before their discharge; reactive hyperaemia index <1.67 was defined as endothelial dysfunction. The main outcomes were the incidence of major bleeding, all-cause death, cardiovascular death, non-cardiovascular death, resuscitated cardiac arrest, non-fatal myocardial infarction, non-fatal stroke, and hospitalisation for heart failure.
Results:
Among the included 674 patients with acute coronary syndrome, 264 (39.2%) had endothelial dysfunction. Multivariable Cox-hazard analyses revealed an independent predictive value of endothelial dysfunction for major bleeding (hazard ratio 2.29, 95% confidence interval 1.17-4.48, P = 0.016) and major adverse cardiovascular events (hazard ratio 2.04, 95% confidence interval 1.43-2.89, P < 0.001). The endothelial dysfunction group patients had a 2.5-fold greater risk of cardiovascular death; however, no association was found with non-cardiovascular death.
Conclusion:
Endothelial dysfunction assessed using reactive hyperaemia index predicted future major cardiovascular event as well as major bleeding and cardiovascular death in patients with acute coronary syndrome.
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