Abstract 389: Coronary Endothelial Dysfunction Is Associated With Increased Risk of Bleeding Events
Background: Coronary endothelial dysfunction(CED) may reflect loss of vascular integrity and permeability. We aimed to test the hypothesis that CED may be associated with increased risk of bleeding events.
Methods: Coronary vascular reactivity was evaluated in 444 patients with non-obstructive coronary arteries by administration of intracoronary acetylcholine during angiography. CED was defined as a ≤ 50% increase in coronary blood flow (CBF) from baseline in response to maximal dose of acetylcholine. After a median follow-up of 7 years, patients were assessed for the occurrence of any significant bleeding events.
Results: Of 444 patients, 70.7% (314) were female. Average age was 52.3 years. Of 252 patients with CED, 7.9% (20) developed bleeding events compared to 2.1% (4 of 192) without CED (p=0.004). Patients who developed bleeding events had a lower percent change in CBF vs. those who did not median: (IQR) 14.1 (-28.1, 98.7) vs. 40.0 (-11.0, 103.5); p=0.03 (Figure 1). CED was significantly associated with the development of bleeding in univariate analysis(p=0.004, relative risk: 3.81 CI, 1.32, 10.96). In multivariate analysis CED was an independent predictor of development of bleeding (p=0.01)
Conclusions: CED is associated with increased risk of bleeding events. This can be explained by the altered vascular function that is inherent to CED. This study underscores the systemic involvement of the endothelium in vascular disease, and the concept of the ‘vulnerable patient’.
Author Disclosures: M. Prasad: None. M. Reriani: None. L.O. Lerman: None. A. Lerman: None.
- © 2015 by American Heart Association, Inc.