Flow-Mediated Dilation (FMD) predicts prognosis in ACS: PR patients with low FMD had significantly higher MACE risk (HR 5.44, P=0.008) than PR patients with high FMD.
Does Flow-Mediated Dilation (FMD) have a prognostic impact on MACE in ACS patients with plaque erosion versus plaque rupture?
Low FMD is a significant predictor of major adverse cardiac events in ACS patients with plaque rupture, but its prognostic impact may vary depending on the culprit lesion type.
Absolute Event Rate: 0% vs 0%
Abstract Background Vascular endothelial function plays an important role in the pathophysiology of acute coronary syndrome (ACS). Plaque erosion (PE) and plaque rupture (PR) are two major mechanisms of ACS, but how vascular endothelial function differs is not well understood. In particular, PE often lacks traditional coronary risk factors, and vascular endothelial function may play an important role. Flow Mediated Dilation (FMD) is a method to evaluate vascular endothelial function by applying pressure with a cuff to the brachial artery and measuring the rate of change in vessel diameter when the cuff is released. We aimed to assess endothelial function through FMD in patients with PE versus PR. Methods ACS patients who underwent primary percutaneous coronary intervention (PCI) with optical frequency domain imaging (OFDI) and FMD assessment at our hospital were retrospectively enrolled from April 2016 to May 2024. Culprit plaque was categorized as PE or PR by OFDI. Because the median value of FMD was 4.1% in our data, the patient was further considered as High FMD (＞4.1) or low FMD (≦4.1). Altogether, based on the culprit plaque and FMD value, patients were divided into PR-High, PR-Low, PE-High, PE-Low and clinical characteristics were compared. Major adverse cardiac event (MACE) was defined as cardiovascular death, nonfatal myocardial infarction, stroke, ischemia driven revascularization, hospitalization for angina and heart failure. Results Overall, FMD was similarly impaired between PE and PR (4.2% vs 4.1%, P=0.85). Clinical characteristics are shown in table. Majority of clinical factors did not differ except for relatively greater prevalence of female in PE-Low. Kaplan-Meier survival curve of MACE is shown in figure. PR-High group showed greatest event-free survival followed by PE-Low (HR=2.62, CI=0.58-11.7, P=0.21), PE-High(HR=3.18, CI=0.76-13.3,P=0.11) and PR-Low (HR=5.44, CI=1.55-19.1, P=0.008). Conclusion FMD likely to have a prognostic impact on ACS patients, which might be variable depending on the culprit lesion.
Ishii et al. (Sat,) reported a other. Flow-Mediated Dilation (FMD) predicts prognosis in ACS: PR patients with low FMD had significantly higher MACE risk (HR 5.44, P=0.008) than PR patients with high FMD.