Persistent Impairment of Endothelial Vasomotor Function
Has a Negative impact on Outcome in Patients with
Coronary Artery disease. Kitta et al, JACC 2009
Method: 251 patients with newly diagnosed coronary artery disease and an impaired flow-mediated
dilation (FMD) of the brachial artery (FMD5.5%). After the first FMD measurement, all patients had
individualized, optimized therapies including medications and life-style changes to reduce risk factors for
CAD according to the AHA/ACC guidelines. Measurement of FMD was repeated after 6 months.
After that, patients were followed up for 36 months or until 1 of the following events occurred:
cardiac death, nonfatal myocardial infarction, recurrent and refractory angina pectoris requiring coronary
revascularization or ischemic stroke.
Results: FMD was persistently impaired (<5.5%) in 104 (41%) patients after 6 months of optimized
therapy, whereas it improved (FMD ≥5.5%) in the remaining 147 (59%) patients. During 36 months
of follow-up, events occurred in 27 (26%) patients with persistently impaired FMD and in 15 (10%)
patients with improved FMD (p0.01). Multivariate Cox hazards analysis showed that persistent
impairment of FMD was an independent predictor of events (hazard ratio: 2.9, 95% confidence
interval: 1.5 to 6.2, p0.01).
Conclusion: Persistent impairment of endothelial vasomotor function despite optimized therapy to
reduce risk factors has an adverse impact on outcome in coronary artery disease patients.
- Method: 251 patients with newly diagnosed coronary artery disease and an impaired flow-mediated