Endothelial Dysfunction Has Great Impacts On The Development Of Acute Coronary Syndrome And Fatal Cardiovascular Events

Endothelial dysfunction is thought to contribute to atherothrombogenic process, however we identify little about practical relationship between clinical evolution of acute coronary syndrome (ACS) and endothelial dysfunction. This study investigated whether endothelial dysfunction has clinical impact on development of ACS. Endothelial dysfunction was graded by ultrasonic measured reactive changes in lumen diameter of right brachial artery following transient forearm occlusion for 5 minutes (FMD; flow-mediated endothelium-dependent vasodilation) in consecutive 518 patients with suspected coronary artery disease. The enrolled patients were categorized into three groups according to the values of FMD, and their cardiovascular events were prospectively followed-up for no less than 36 months. For a mean follow-up period of 60 months with 100% follow-up, the patients with severe endothelial dysfunction (FMD<4%; Group-L, n=174), more frequently developed ACS than Group-M with mild endothelial dysfunction (4%≤FMD<8%, n=171) plus Group-H with preserved endothelial function (FMD 8% or more, Group-H, n=173) (p<0.001, by Kaplan-Meier analysis] and majority of the patients with fatal cardiovascular events belonged to group-L. Cox proportional hazard model analysis showed that severe endothelial dysfunction was the most powerful predictor for future development of ACS (hazard ratio=5.77, 95%confidential interval; 2.52–13.22, p<0.001) and fatal cardiovascular events (hazard ratio=10.34, 95%confidential interval; 1.26 –72.25, p=0.022). These results suggest endothelial dysfunction plays important roles on development of ACS and fatal cardiovascular events in the near future, and strategies based on practical status of endothelial function are required to prevent ACS and fatal cardiovascular events. Cumulative Incidence