Factors affecting in-stent restenosis and the role of flow-mediated dilatation

Gökhan Bektaşoğlu; Zeki Doğan; Ahmet Yilmaz

doi:10.7197/cmj.874258

Research Article

Year 2021, Volume: 43 Issue: 3, 217 - 225, 30.09.2021

Gökhan Bektaşoğlu Zeki Doğan Ahmet Yilmaz

https://doi.org/10.7197/cmj.874258

Abstract

References

1. Townsend N, Nichols M, Scarborough P, Rayner M. Cardiovascular disease in Europe—epidemiological update 2015. Eur Heart J. 2015;36(40):2696-705.
2. Timmis A, Townsend N, Gale C, et al.; ESC Scientific Document Group. European Society of Cardiology: Cardiovascular Disease Statistics 2017. Eur Heart J. 2018;39(7):508-79.
3. Gimbrone MA Jr, García-Cardeña G. Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis. Circ Res. 2016;118(4):620-36.
4. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature. 1993;362(6423):801-9.
5. Thijssen DHJ, Bruno RM, van Mil ACCM, et al. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans Eur Heart J. 2019;40(30):2534-47.
6. Ras RT, Streppel MT, Draijer R, Zock PL. Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol. 2013;168(1):344-51.
7. Matsuzawa Y, Kwon TG, Lennon RJ, Lerman LO, Lerman A. Prognostic Value of Flow-Mediated Vasodilation in Brachial Artery and Fingertip Artery for Cardiovascular Events: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2015;4(11):e002270.
8. Xu Y, Arora RC, Hiebert BM, et al. Non-invasive endothelial function testing and the risk of adverse outcomes: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2014;15(7):736-46.
9. Green DJ, Jones H, Thijssen D, Cable NT, Atkinson G. Flow-mediated dilation and cardiovascular event prediction: does nitric oxide matter? Hypertension. 2011;57(3):363-9.
10. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-421.
11. Kristian Thygesen; Joseph S. Alpert; Harvey D. White, on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal Definition of Myocardial Infarction. Circulation. 2007;116(22):2634-53.
12. TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985 Apr 4;312(14):932-6.
13. Libby PP, Bonow RO, Mann DL, Zipes DP. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th edition. Philadelphia: Elsevier Science, 2007:20:465-500.
14. Gensini GG. Coronary arteriogaphy. Mount Kisco, New York: Futura Publishing Co, 1975.
15. Ellis SG, Vandormael MG, Cowley MJ, et al. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. Circulation. 1990;82(4):1193-202.
16. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340(2):115-26.
17. Halcox JP, Quyyumi AA. Coronary vascular endothelial function and myocardial ischemia: why should we worry about endothelial dysfunction? Coron Artery Dis. 2001;12(6):475-84.
18. Perticone F, Ceravolo R, Pujia A, et al. Prognostic significance of endothelial dysfunction in hypertensive patients. Circulation. 2001;104(2):191-6.
19. Halcox JP, Schenke WH, Zalos G, et al. Prognostic value of coronary vascular endothelial dysfunction. Circulation. 2002;106(6):653–8.
20. Fichtlscherer S, Breuer S, Zeiher AM. Prognostic value of systemic endothelial dysfunction in patients with acute coronary syndromes: further evidence for the existence of the "vulnerable" patient. Circulation. 2004;110(14):1926-32.
21. Anderson TJ, Uehata A, Gerhard MD, et al. Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol. 1995;26(5):1235–41.
22. Lau KK, Chan YH, Yiu KH, et al. Incremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of low-intermediate risk. Postgrad Med J. 2008;84(989):153–7.
23. Patti G, Pasceri V, Melfi R, et al. Impaired flow-mediated dilation and risk of restenosis in patients undergoing coronary stent implantation. Circulation. 2005;111(1):70–5.
24. Kitta Y, Nakamura T, Kodama Y, et al. Endothelial vasomotor dysfunction in the brachial artery is associated with late in-stent coronary restenosis. J Am Coll Cardiol. 2005;46(4):648-55.
25. Lowe HC, Oesterle SN, Khachigian LM. Coronary in-stent restenosis: current status and future strategies. J Am Coll Cardiol. 2002;39(2):183-93.
26. Rajagopal V, Rockson SG. Coronary restenosis: a review of mechanisms and management. Am J Med. 2003;115(7):547–53.
27. Wang G, Jacquet L, Karamariti E, Xu Q. Origin and differentiation of vascular smooth muscle cells. J Physiol. 2015;593(14):3013-30.
28. Bønaa KH, Mannsverk J, Wiseth R, et al.; NORSTENT Investigators. Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease. N Engl J Med. 2016;375(13):1242-52.
29. Kubo M, Miyoshi T, Oe H, et al. Prognostic significance of endothelial dysfunction in patients undergoing percutaneous coronary intervention in the era of drug-eluting stents. BMC Cardiovasc Disord. 2015;15:102.
30. Yamawaki T, Yamada A, Fukumoto Y, et al. Statin therapy may prevent restenosis after successful coronary intervention, independent of lipid-lowering effect and CRP level. Fukuoka Igaku Zasshi. 2007;98(6):260–9.
31. Yamamoto T, Takeda K, Harada S, et al. HMG-CoA reductase inhibitor enhances inducible nitric oxide synthase expression in rat vascular smooth muscle cells; involvement of the Rho/Rho kinase pathway. Atherosclerosis. 2003;166(2):213–22.
32. Virdis A, Colucci R, Versari D, et al. Atorvastatin prevents endothelial dysfunction in mesenteric arteries from spontaneously hypertensive rats: role of cyclooxygenase 2-derived contracting prostanoids. Hypertension. 2009;53(6):1008–16.
33. Simova II, Denchev SV, Dimitrov SI. Effects of statins on endothelial function in patients with coronary artery disease. Clin Cardiol. 2009;32(4):193-8.
34. Bae JH, Bassenge E, Kim KY, et al. Effects of low-dose atorvastatin on vascular responses in patients undergoing percutaneous coronary intervention with stenting. J Cardiovasc Pharmacol Ther. 2004;9(3):185–92.
35. Erl W, Hristov M, Neureuter M, et al. HMG-CoA reductase inhibitors induce apoptosis in neointima-derived vascular smooth muscle cells. Atherosclerosis. 2003;169(2):251–8.
36. Erl W. Statin-induced vascular smooth muscle cell apoptosis: a possible role in the prevention of restenosis? Curr Drug Targets Cardiovasc Haematol Disord. 2005;5(2):135–44.

Factors affecting in-stent restenosis and the role of flow-mediated dilatation

Year 2021, Volume: 43 Issue: 3, 217 - 225, 30.09.2021

Gökhan Bektaşoğlu Zeki Doğan Ahmet Yilmaz

https://doi.org/10.7197/cmj.874258

Abstract

Objective: In-stent restenosis is a major problem concerning percutaneous coronary interventions. Brachial artery flow-mediated dilation, a non-invasive indicator of endothelial dysfunction, and its relationship with future cardiovascular events is well known.

The aim of this study was to identify factors thought to have an effect on in-stent restenosis and to test the predictive value of flow-mediated dilatation.

Method: 74 consecutive patients who were treated with bare-metal stents and recommended control coronary angiography during their follow-up were included into the study. Patients were categorized into 2 groups in the form of those having in-stent restenosis (n=35) and no in-stent restenosis (n=39). Clinical, biochemical, angiographic parameters and also flow-mediated dilatation was evaluated.

Results: Flow-mediated dilatation was significantly impaired in patients with in-stent restenosis than in patients with no in-stent restenosis (5.1(4.8) % vs. 9.2(4.1) %, p<0.001). After multivariable analysis; flow-mediated dilatation (p=0.004), stent diameter (p=0.014), stent length (p=0.01), no use of statins (p=0.017) and absence of TIMI-3 flow (p=0.039) were found as independent predictors of in-stent restenosis. According to the receiver-operating characteristic curve analysis, optimal cut-off value of flow-mediated dilatation to predict in-stent restenosis was measured to be ≤6.8%, with 75.8% sensitivity and 78.8% specificity (Area under curve 0.764, 95% confidence interval 0.644-0.885).

Conclusions: Our study suggested that flow-mediated dilatation may contribute to the identification of high-risk patients who will develop in-stent restenosis after percutaneous coronary interventions.

Keywords

Stent, Restenosis, flow-mediated dilatation

References

1. Townsend N, Nichols M, Scarborough P, Rayner M. Cardiovascular disease in Europe—epidemiological update 2015. Eur Heart J. 2015;36(40):2696-705.
2. Timmis A, Townsend N, Gale C, et al.; ESC Scientific Document Group. European Society of Cardiology: Cardiovascular Disease Statistics 2017. Eur Heart J. 2018;39(7):508-79.
3. Gimbrone MA Jr, García-Cardeña G. Endothelial Cell Dysfunction and the Pathobiology of Atherosclerosis. Circ Res. 2016;118(4):620-36.
4. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature. 1993;362(6423):801-9.
5. Thijssen DHJ, Bruno RM, van Mil ACCM, et al. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans Eur Heart J. 2019;40(30):2534-47.
6. Ras RT, Streppel MT, Draijer R, Zock PL. Flow-mediated dilation and cardiovascular risk prediction: a systematic review with meta-analysis. Int J Cardiol. 2013;168(1):344-51.
7. Matsuzawa Y, Kwon TG, Lennon RJ, Lerman LO, Lerman A. Prognostic Value of Flow-Mediated Vasodilation in Brachial Artery and Fingertip Artery for Cardiovascular Events: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2015;4(11):e002270.
8. Xu Y, Arora RC, Hiebert BM, et al. Non-invasive endothelial function testing and the risk of adverse outcomes: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging. 2014;15(7):736-46.
9. Green DJ, Jones H, Thijssen D, Cable NT, Atkinson G. Flow-mediated dilation and cardiovascular event prediction: does nitric oxide matter? Hypertension. 2011;57(3):363-9.
10. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-421.
11. Kristian Thygesen; Joseph S. Alpert; Harvey D. White, on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal Definition of Myocardial Infarction. Circulation. 2007;116(22):2634-53.
12. TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985 Apr 4;312(14):932-6.
13. Libby PP, Bonow RO, Mann DL, Zipes DP. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th edition. Philadelphia: Elsevier Science, 2007:20:465-500.
14. Gensini GG. Coronary arteriogaphy. Mount Kisco, New York: Futura Publishing Co, 1975.
15. Ellis SG, Vandormael MG, Cowley MJ, et al. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. Circulation. 1990;82(4):1193-202.
16. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340(2):115-26.
17. Halcox JP, Quyyumi AA. Coronary vascular endothelial function and myocardial ischemia: why should we worry about endothelial dysfunction? Coron Artery Dis. 2001;12(6):475-84.
18. Perticone F, Ceravolo R, Pujia A, et al. Prognostic significance of endothelial dysfunction in hypertensive patients. Circulation. 2001;104(2):191-6.
19. Halcox JP, Schenke WH, Zalos G, et al. Prognostic value of coronary vascular endothelial dysfunction. Circulation. 2002;106(6):653–8.
20. Fichtlscherer S, Breuer S, Zeiher AM. Prognostic value of systemic endothelial dysfunction in patients with acute coronary syndromes: further evidence for the existence of the "vulnerable" patient. Circulation. 2004;110(14):1926-32.
21. Anderson TJ, Uehata A, Gerhard MD, et al. Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol. 1995;26(5):1235–41.
22. Lau KK, Chan YH, Yiu KH, et al. Incremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of low-intermediate risk. Postgrad Med J. 2008;84(989):153–7.
23. Patti G, Pasceri V, Melfi R, et al. Impaired flow-mediated dilation and risk of restenosis in patients undergoing coronary stent implantation. Circulation. 2005;111(1):70–5.
24. Kitta Y, Nakamura T, Kodama Y, et al. Endothelial vasomotor dysfunction in the brachial artery is associated with late in-stent coronary restenosis. J Am Coll Cardiol. 2005;46(4):648-55.
25. Lowe HC, Oesterle SN, Khachigian LM. Coronary in-stent restenosis: current status and future strategies. J Am Coll Cardiol. 2002;39(2):183-93.
26. Rajagopal V, Rockson SG. Coronary restenosis: a review of mechanisms and management. Am J Med. 2003;115(7):547–53.
27. Wang G, Jacquet L, Karamariti E, Xu Q. Origin and differentiation of vascular smooth muscle cells. J Physiol. 2015;593(14):3013-30.
28. Bønaa KH, Mannsverk J, Wiseth R, et al.; NORSTENT Investigators. Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease. N Engl J Med. 2016;375(13):1242-52.
29. Kubo M, Miyoshi T, Oe H, et al. Prognostic significance of endothelial dysfunction in patients undergoing percutaneous coronary intervention in the era of drug-eluting stents. BMC Cardiovasc Disord. 2015;15:102.
30. Yamawaki T, Yamada A, Fukumoto Y, et al. Statin therapy may prevent restenosis after successful coronary intervention, independent of lipid-lowering effect and CRP level. Fukuoka Igaku Zasshi. 2007;98(6):260–9.
31. Yamamoto T, Takeda K, Harada S, et al. HMG-CoA reductase inhibitor enhances inducible nitric oxide synthase expression in rat vascular smooth muscle cells; involvement of the Rho/Rho kinase pathway. Atherosclerosis. 2003;166(2):213–22.
32. Virdis A, Colucci R, Versari D, et al. Atorvastatin prevents endothelial dysfunction in mesenteric arteries from spontaneously hypertensive rats: role of cyclooxygenase 2-derived contracting prostanoids. Hypertension. 2009;53(6):1008–16.
33. Simova II, Denchev SV, Dimitrov SI. Effects of statins on endothelial function in patients with coronary artery disease. Clin Cardiol. 2009;32(4):193-8.
34. Bae JH, Bassenge E, Kim KY, et al. Effects of low-dose atorvastatin on vascular responses in patients undergoing percutaneous coronary intervention with stenting. J Cardiovasc Pharmacol Ther. 2004;9(3):185–92.
35. Erl W, Hristov M, Neureuter M, et al. HMG-CoA reductase inhibitors induce apoptosis in neointima-derived vascular smooth muscle cells. Atherosclerosis. 2003;169(2):251–8.
36. Erl W. Statin-induced vascular smooth muscle cell apoptosis: a possible role in the prevention of restenosis? Curr Drug Targets Cardiovasc Haematol Disord. 2005;5(2):135–44.

There are 36 citations in total.

Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Medical Science Research Articles
Authors	Gökhan Bektaşoğlu 0000-0002-4571-7908 Zeki Doğan 0000-0002-5620-7268 Ahmet Yilmaz 0000-0002-9832-8981
Publication Date	September 30, 2021
Acceptance Date	September 25, 2021
Published in Issue	Year 2021Volume: 43 Issue: 3

Cite

AMA	Bektaşoğlu G, Doğan Z, Yilmaz A. Factors affecting in-stent restenosis and the role of flow-mediated dilatation. CMJ. September 2021;43(3):217-225. doi:10.7197/cmj.874258

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