Endothelial vasomotor dysfunction in the brachial artery is associated with late in-stent coronary restenosis

OBJECTIVES This study examined whether endothelial dysfunction in the brachial artery might be associated with late in-stent restenosis (ISR) after percutaneous coronary intervention (PCI). BACKGROUND Simple and noninvasive identification of late ISR might help to select patients who require further angiographic evaluation. METHODS Endothelium-dependent flow-mediated dilation (FMI) of the brachial artery was measured before (initial FMD) and at six months (follow-up FMD) after PCI in 141 consecutive patients who had elective and successful PCI with bare metal stents in de novo lesions of native coronary arteries for symptomatic coronary artery, disease. Follow-tip angiography was performed at six months after PCI in all patients. RESULTS With multivariate logistic regression analysis, the impairment (<= 4.8 % dilation from baseline diameter) of FMD at follow-up showed the strongest association with late ISR (defined as > 50 % diameter stenosis, n = 46) independently of other clinical and angiographic variables known to be associated with ISR (odds ratio 7.4, 95 % confidence interval 2.8 to 19.2, p < 0.001), whereas the initial FMD did not have the association. The sensitivity of impaired FMD at follow-up (69 %) in detecting ISR was higher than chest pain during the follow-up period (45 %), with comparable specificity. The impaired FMD in combination with the chest pain increased the sensitivity to 90 %. CONCLUSIONS The impairment of FMD in the brachial artery at the time of follow-up was independently and closely associated with late ISR in native coronary arteries. The noninvasive assessment of FMD at the time of follow-up might be useful for identification of late ISR. (c) 2005 by the American College of Cardiology Foundation.