P299	Improvement in rather than single assessment of brachial artery endothelial function predicts cardiovascular events in coronary artery disease patients.
A.Suessenbacher, M.Frick, H.Alber, O.Pachinger, F.Weidinger
Division of Cardiology, Innsbruck Medical University, Innsbruck, AT.

Background: Peripheral endothelial function, assessed by brachial artery flow-mediated dilation (BA-FMD), has been related to cardiovascular risk factors as well as the presence of coronary artery disease (CAD). Data on the prognostic value of single FMD measurements for future cardiovascular events are conflicting. Whether serial measurements improve the predictive value of this test is unknown. Methods: In a pilot-study, 68 patients (mean age 53.7 ± 9.1 years), with angiographically proven coronary artery disease (≥30% stenosis in ≥1 major vessel), underwent assessment of FMD at baseline and again after a mean time of 14 ± 12 months. Patients were divided into 2 groups: absolute improvement in FMD ≥3% (group 1) and <3% (group 2). This cutoff value was chosen based on the evaluation of the spontaneous variability which was 3% in 16 CAD patients tested within 3 months. After a mean follow-up of 44 ± 12 months cardiovascular events (hospitalisation due to angina, repeat coronary angiography revealing de novo or significant progression of preexisting stenosis, coronary revascularisation, myocardial infarction, cardiac death) were recorded by phone calls to the patients, followed by review of hospital charts. Results: Baseline characteristics were similar between groups, except the number of risk factors which was smaller in group 1 (1.6 ± 0.7 vs. 2.1 ± 0.8, p<0.01). Baseline medication was comparable between groups (use of statins, angiotensin converting enzyme inhibitors, angiotensin-II receptor antagonists). Cardiovascular events occured more frequent in group 2 (9 vs. 1 event; p<0.05). In Kaplan Meier analysis, the difference was only borderline significant (p=0.08), due to the small number of subjects. Interestingly, when patients were divided according to the single baseline median FMD value, no significant difference in the number of events was found between groups (4 vs. 6 events; p=0.49). Conclusion: These data suggest that an increase in FMD is associated with improved outcome in CAD patients. Thus the change in FMD may be a better predictor of future cardiovascular events and may more accurately reflect susceptibility of the vasculature for cardiovascular risk factors than a single FMD measurement.

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