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Impact of Endothelial Dysfunction on Long-Term Clinical Outcomes in Patients With Chronic Coronary Syndromes Treated

Luca Paolucci1, Fabio Mangiacapra1, Michele Mattia Viscusi1

  • 1Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|February 22, 2023
PubMed

Insights

Endothelial dysfunction (ED) does not increase the risk of adverse cardiovascular events in patients with stable coronary artery disease (CAD) treated with second-generation drug-eluting stents (DES). Long-term follow-up shows no significant association between ED and major adverse cardiac events (MACE).

Area of Science:

  • Cardiology
  • Vascular Biology
  • Interventional Cardiology

Background:

  • Endothelial dysfunction (ED) is a condition affecting blood vessel function.
  • Its impact on clinical outcomes after percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) using second-generation drug-eluting stents (DES) remains understudied.
  • This study addresses this gap by investigating the relationship between ED and adverse cardiovascular events.

Purpose of the Study:

  • To investigate the clinical outcomes of patients with and without endothelial dysfunction (ED) treated with second-generation drug-eluting stents (DES) for stable coronary artery disease (CAD).
  • To determine if ED is associated with an increased risk of major adverse cardiovascular events (MACE) or other adverse outcomes after PCI.

Main Methods:

  • A prospective cohort study included 109 patients undergoing PCI with second-generation DES for stable CAD.
  • Endothelial dysfunction (ED) was assessed by flow-mediated dilation (FMD) of the brachial artery, with ED defined as FMD < 7%.
  • Five-year follow-up data were collected to evaluate major adverse cardiovascular events (MACE), target vessel revascularization (TVR), myocardial infarction (MI), and all-cause death.

Main Results:

  • No significant difference in median FMD was observed between patients who experienced adverse outcomes and those who did not.
  • There was no statistically significant association between ED and an increased risk of MACE, TVR, MI, or all-cause death at five-year follow-up.
  • These findings were consistent across different definitions of ED and at one-year landmark analyses.

Conclusions:

  • Endothelial dysfunction (ED) is not associated with an increased risk of adverse cardiovascular events in patients with stable coronary artery disease (CAD) undergoing PCI with second-generation DES.
  • The study suggests that ED may not be a significant prognostic factor in this specific patient population.
  • Long-term follow-up confirms the lack of association between ED and adverse outcomes in contemporary PCI practice.
Abstract

Keywords:
Coronary artery diseaseCoronary revascularizationEndothelial dysfunction

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