Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy.
Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy.
Cardiovasc Revasc Med. 2023 Jun;51:18-22. doi: 10.1016/j.carrev.2023.02.003. Epub 2023 Feb 8.
Studies investigating clinical outcomes of patients with or without endothelial disfunction (ED) treated with percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) using second generation drug eluting stents (DES) are lacking.
We prospectively collected data from 109 patients undergoing PCI with second generation DES due to stable CAD between December 2014 and September 2016. ED was evaluated evaluating the flow mediated dilation (FMD) at the brachial artery level and defined by an FMD < 7 %. Primary outcome were major adverse cardiovascular events (MACE), secondary outcomes were target vessel failure (TVR), myocardial infarction (MI) and all-cause death.
Five-year follow-up was available in all patients. Median FMD didn't significantly differ between patients who experienced the outcome and those who didn't [no TVR vs. TVR: p = 0.358; no MI vs. MI: p = 0.157; no death vs. death: p = 0.355; no MACE vs. MACE: p = 0.805]. No association between ED and an increased risk for the primary outcome as well as for the secondary ones was evident [MACE: 17.0 % vs. 14.3 %, HR 0.87 (0.33-2.26), log rank p = 0.780; TVR: 9.4 % vs. 5.4 %, HR 0.53 (0.12-2.24), log rank p = 0.384; MI: 3.7 % vs. 8.9 %, HR 2.46 (0.47-12.76), log rank p = 0.265; death: 7.5 % vs. 3.6 %, HR 0.53 (0.09-2.90), log rank p = 0.458]. These findings were confirmed using a lower threshold of FMD to define ED and at one-year landmark analysis.
ED is not associated with an increased risk of adverse events at long-term follow-up in a contemporary cohort of patients undergoing PCI with second generation DES.
使用第二代药物洗脱支架（DES）行经皮冠状动脉介入治疗（PCI）治疗稳定型冠状动脉疾病（CAD）的患者中，关于内皮功能障碍（ED）患者与无 ED 患者的临床结局的研究尚缺乏。
我们前瞻性地收集了 2014 年 12 月至 2016 年 9 月期间 109 例因稳定型 CAD 而行 PCI 治疗且使用第二代 DES 的患者的数据。通过肱动脉血流介导的舒张功能（FMD）评估 ED，并将 FMD<7%定义为 ED。主要结局为主要不良心血管事件（MACE），次要结局为靶血管失败（TVR）、心肌梗死（MI）和全因死亡。
所有患者均获得了 5 年随访。发生结局事件和未发生结局事件的患者之间的中位 FMD 无显著差异[无 TVR 与 TVR：p=0.358；无 MI 与 MI：p=0.157；无死亡与死亡：p=0.355；无 MACE 与 MACE：p=0.805]。ED 与主要结局以及次要结局的风险增加之间没有明显关联[MACE：17.0%比 14.3%，HR 0.87（0.33-2.26），对数秩检验 p=0.780；TVR：9.4%比 5.4%，HR 0.53（0.12-2.24），对数秩检验 p=0.384；MI：3.7%比 8.9%，HR 2.46（0.47-12.76），对数秩检验 p=0.265；死亡：7.5%比 3.6%，HR 0.53（0.09-2.90），对数秩检验 p=0.458]。使用较低的 FMD 阈值来定义 ED 以及在 1 年的里程碑分析中，也得到了相同的结果。
在当代接受第二代 DES 行 PCI 治疗的患者队列中，ED 与长期随访时不良事件的风险增加无关。
