Coronary endothelial function testing provides superior discrimination compared with standard clinical risk scoring in prediction of cardiovascular events

Martin Reriani, Jaskanwal D. Sara, Andreas J. Flammer, Rajiv Gulati, Jing Li, Charanjit Rihal, Ryan Lennon, Lilach O Lerman, Amir Lerman

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND: Endothelial dysfunction is regarded as the early stage of atherosclerosis and is associated with cardiovascular (CV) events. This study was designed to determine whether assessment of coronary endothelial function (CEF) is safe and can reclassify risk in patients with early coronary artery disease beyond the Framingham risk score (FRS). METHODS AND RESULTS: CEF was evaluated using intracoronary acetylcholine in 470 patients who presented with chest pain and nonobstructive coronary artery disease. CV events were assessed after a median follow-up of 9.7 years. The association between CEF and CV events was examined, and the net reclassification improvement index (NRI) was used to compare the incremental contribution of CEF when added to FRS.The mean age was 53 years, and 68% of the patients were women with a median FRS of 8. Complications (coronary dissection) occurred in three (0.6%) and CV events in 61 (13%) patients. In univariate analysis, microvascular CEF [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.72–0.97, P=0.032] and epicardial CEF (HR 0.73, 95% CI 0.59–0.90, P=0.01) were found to be significant predictors of CV events, whereas FRS was not (HR 1.05, 95% CI 0.85–1.26, P=0.61). When added to FRS, microvascular CEF correctly reclassified 11.3% of patients [NRI 0.11 (95% CI 0.019–0.21)], epicardial CEF correctly reclassified 12.1% of patients [NRI 0.12 (95% CI −0.02 to 0.26)], and the combined microvascular and epicardial CEF correctly reclassified 22.8% of patients [NRI 0.23 (95% CI 0.08–0.37)]. CONCLUSION: CEF testing is safe and adds value to the FRS, with superior discrimination and risk stratification compared with FRS alone in patients presenting with chest pain or suspected ischemia.

Original languageEnglish (US)
JournalCoronary Artery Disease
DOIs
StateAccepted/In press - Feb 12 2016

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Confidence Intervals
Chest Pain
Coronary Artery Disease
Acetylcholine
Dissection
Atherosclerosis
Ischemia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Coronary endothelial function testing provides superior discrimination compared with standard clinical risk scoring in prediction of cardiovascular events. / Reriani, Martin; Sara, Jaskanwal D.; Flammer, Andreas J.; Gulati, Rajiv; Li, Jing; Rihal, Charanjit; Lennon, Ryan; Lerman, Lilach O; Lerman, Amir.

In: Coronary Artery Disease, 12.02.2016.

Research output: Contribution to journalArticle

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title = "Coronary endothelial function testing provides superior discrimination compared with standard clinical risk scoring in prediction of cardiovascular events",
abstract = "BACKGROUND: Endothelial dysfunction is regarded as the early stage of atherosclerosis and is associated with cardiovascular (CV) events. This study was designed to determine whether assessment of coronary endothelial function (CEF) is safe and can reclassify risk in patients with early coronary artery disease beyond the Framingham risk score (FRS). METHODS AND RESULTS: CEF was evaluated using intracoronary acetylcholine in 470 patients who presented with chest pain and nonobstructive coronary artery disease. CV events were assessed after a median follow-up of 9.7 years. The association between CEF and CV events was examined, and the net reclassification improvement index (NRI) was used to compare the incremental contribution of CEF when added to FRS.The mean age was 53 years, and 68{\%} of the patients were women with a median FRS of 8. Complications (coronary dissection) occurred in three (0.6{\%}) and CV events in 61 (13{\%}) patients. In univariate analysis, microvascular CEF [hazard ratio (HR) 0.85, 95{\%} confidence interval (CI) 0.72–0.97, P=0.032] and epicardial CEF (HR 0.73, 95{\%} CI 0.59–0.90, P=0.01) were found to be significant predictors of CV events, whereas FRS was not (HR 1.05, 95{\%} CI 0.85–1.26, P=0.61). When added to FRS, microvascular CEF correctly reclassified 11.3{\%} of patients [NRI 0.11 (95{\%} CI 0.019–0.21)], epicardial CEF correctly reclassified 12.1{\%} of patients [NRI 0.12 (95{\%} CI −0.02 to 0.26)], and the combined microvascular and epicardial CEF correctly reclassified 22.8{\%} of patients [NRI 0.23 (95{\%} CI 0.08–0.37)]. CONCLUSION: CEF testing is safe and adds value to the FRS, with superior discrimination and risk stratification compared with FRS alone in patients presenting with chest pain or suspected ischemia.",
author = "Martin Reriani and Sara, {Jaskanwal D.} and Flammer, {Andreas J.} and Rajiv Gulati and Jing Li and Charanjit Rihal and Ryan Lennon and Lerman, {Lilach O} and Amir Lerman",
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T1 - Coronary endothelial function testing provides superior discrimination compared with standard clinical risk scoring in prediction of cardiovascular events

AU - Reriani, Martin

AU - Sara, Jaskanwal D.

AU - Flammer, Andreas J.

AU - Gulati, Rajiv

AU - Li, Jing

AU - Rihal, Charanjit

AU - Lennon, Ryan

AU - Lerman, Lilach O

AU - Lerman, Amir

PY - 2016/2/12

Y1 - 2016/2/12

N2 - BACKGROUND: Endothelial dysfunction is regarded as the early stage of atherosclerosis and is associated with cardiovascular (CV) events. This study was designed to determine whether assessment of coronary endothelial function (CEF) is safe and can reclassify risk in patients with early coronary artery disease beyond the Framingham risk score (FRS). METHODS AND RESULTS: CEF was evaluated using intracoronary acetylcholine in 470 patients who presented with chest pain and nonobstructive coronary artery disease. CV events were assessed after a median follow-up of 9.7 years. The association between CEF and CV events was examined, and the net reclassification improvement index (NRI) was used to compare the incremental contribution of CEF when added to FRS.The mean age was 53 years, and 68% of the patients were women with a median FRS of 8. Complications (coronary dissection) occurred in three (0.6%) and CV events in 61 (13%) patients. In univariate analysis, microvascular CEF [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.72–0.97, P=0.032] and epicardial CEF (HR 0.73, 95% CI 0.59–0.90, P=0.01) were found to be significant predictors of CV events, whereas FRS was not (HR 1.05, 95% CI 0.85–1.26, P=0.61). When added to FRS, microvascular CEF correctly reclassified 11.3% of patients [NRI 0.11 (95% CI 0.019–0.21)], epicardial CEF correctly reclassified 12.1% of patients [NRI 0.12 (95% CI −0.02 to 0.26)], and the combined microvascular and epicardial CEF correctly reclassified 22.8% of patients [NRI 0.23 (95% CI 0.08–0.37)]. CONCLUSION: CEF testing is safe and adds value to the FRS, with superior discrimination and risk stratification compared with FRS alone in patients presenting with chest pain or suspected ischemia.

AB - BACKGROUND: Endothelial dysfunction is regarded as the early stage of atherosclerosis and is associated with cardiovascular (CV) events. This study was designed to determine whether assessment of coronary endothelial function (CEF) is safe and can reclassify risk in patients with early coronary artery disease beyond the Framingham risk score (FRS). METHODS AND RESULTS: CEF was evaluated using intracoronary acetylcholine in 470 patients who presented with chest pain and nonobstructive coronary artery disease. CV events were assessed after a median follow-up of 9.7 years. The association between CEF and CV events was examined, and the net reclassification improvement index (NRI) was used to compare the incremental contribution of CEF when added to FRS.The mean age was 53 years, and 68% of the patients were women with a median FRS of 8. Complications (coronary dissection) occurred in three (0.6%) and CV events in 61 (13%) patients. In univariate analysis, microvascular CEF [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.72–0.97, P=0.032] and epicardial CEF (HR 0.73, 95% CI 0.59–0.90, P=0.01) were found to be significant predictors of CV events, whereas FRS was not (HR 1.05, 95% CI 0.85–1.26, P=0.61). When added to FRS, microvascular CEF correctly reclassified 11.3% of patients [NRI 0.11 (95% CI 0.019–0.21)], epicardial CEF correctly reclassified 12.1% of patients [NRI 0.12 (95% CI −0.02 to 0.26)], and the combined microvascular and epicardial CEF correctly reclassified 22.8% of patients [NRI 0.23 (95% CI 0.08–0.37)]. CONCLUSION: CEF testing is safe and adds value to the FRS, with superior discrimination and risk stratification compared with FRS alone in patients presenting with chest pain or suspected ischemia.

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