Introduction: Endothelial dysfunction plays a pivotal role in the progression of atherosclerosis and subsequent cardiovascular events. Advanced endothelial dysfunction in patients with stable coronary disease is known to be significantly correlated with near future cardiovascular events. However, the prognostic value of endothelial dysfunction in patients with ST-segment elevation myocardial infarction (STEMI) is unclear.
Hypothesis: We assessed the hypothesis that endothelial dysfunction is associated with an increased risk of secondary cardiovascular events in patients with STEMI.
Methods: A total of 220 male patients with STEMI were enrolled. We assessed peripheral endothelial function by reactive hyperemia peripheral arterial tonometry (RH-PAT) as RH-PAT index (Ln-RHI). The patients were divided into low and high endothelial function groups using the median value of Ln-RHI. Low endothelial function was defined as Ln-RHI ≤ 0.565. All patients were followed for cardiovascular events, which consist of deaths from any causes, nonfatal myocardial infarctions, and nonfatal ischemic strokes.
Results: During follow-up (median 23 months [interquartile ranges 14 and 32 months]), 18 patients experienced cardiovascular events (6 deaths, 7 myocardial infarctions, 5 ischemic strokes). The event rate at 23 months after STEMI was significantly higher in patients with low Ln-RHI (11.1%) than those with high Ln-RHI (5.7%) (log-rank, p = 0.039) (Figure). Univariate cox proportional hazard analysis demonstrated that patients with low Ln-RHI had 2.8-fold higher risk of subsequent cardiovascular events compared to those without (hazard ratio 2.81, 95% confidence interval 1.06-8.78, p = 0.047). .
Conclusions: Among male patients with STEMI, endothelial dysfunction was significantly associated with an increased risk of future cardiovascular events. Endothelial function with Ln-RHI could provide useful prognostic value in patients with STEMI.