Risk Stratification for Postoperative Cardiovascular Events via Noninvasive Assessment of Endothelial Function

• DOI: 10.1161/01.cir.0000012543.55874.47
• Publication Date: 2002-07-28T23:16:07Z
• Authors: Noyan Gokce; John F. Keaney; Liza M. Hunter; Michael T. Watkins; James O. Menzoian; Joseph A. Vita
• Keywords: Brachial artery; Endothelial Dysfunction; Unstable angina

Background — Brachial artery endothelial function is impaired in individuals with atherosclerosis and coronary risk factors improves reduction therapy. However, the predictive value of brachial dysfunction for future cardiovascular events unknown. Methods Results We preoperatively examined vasodilation using ultrasound 187 patients undergoing vascular surgery. Patients were prospectively followed 30 days after Forty-five had a postoperative event, including cardiac death (3), myocardial infarction (12), unstable angina/ischemic ventricular fibrillation (2), stroke or elevated troponin I, reflecting necrosis (25). Preoperative endothelium-dependent flow-mediated dilation was significantly lower an event (4.9±3.1%) than those without (7.3±5%; P <0.001), whereas endothelium-independent to nitroglycerin similar both groups. In Cox proportional-hazards model, independent predictors age ( =0.001), renal insufficiency =0.03), noncarotid surgery =0.05), =0.007). If I elevation not considered low remained predictor (odds ratio 9.0, 95% CI 1.2 68; =0.03). When cutpoint 8.1% used, sensitivity 95%, specificity 37%, negative 98% events. Conclusions Impaired independently predicts events, which supports role pathogenesis disease. The strong preserved raises possibility that assessment will be useful management