Copyright © 1990 by the European Society of Cardiology.
© 1990 The European Society of Cardiology
Effect of acetylcholine on arterial and grafts and coronary arteries in patients with coronary artery disease
Department OF Cardiology, Georg-August University Goettingen,F.R.G.
Received 20 April 1989; revised 23 June 1989; .
Address for correspondence G.S.WERNER, Department OF Cardiology, University of Goettingen, Robert-Koch Str.40,D-3400 Goettingen, Fed.Rep.Germany
Abstract
Endothelium-dependent vasomotor responses differ in arteries and veins. The transfer of a given vessel from a different vascular bed into the coronary circulation by grafting may affect its endothelial function. In order to evaluate the differences in endothelial function of the internal mammary artery and aortocoronary venous grafts in patients with coronary artery disease, the response to acetylcholine (ach) was examined and compared with that of native coronary arteries.
Eighteen patients were examined, including eight with internal mammary artery grafts (9 days to 48 months after surgery), and 10 with saphenous vein grafts (12-96 months after surgery). Ach (70-700 nmol min-1) was infused selectively into a graft on the left anterior descending coronary artery, and the effect on vessel diameters was assessed by quantitative arteriography.
In both groups 84% and 83%, respectively, of the arterial segments distal to the bypass anastomosis were contracted by ach (
70 nmol min-1. The segments of both groups did not show angiographic evidence of local atherosclerosis. A complete occlusion occured in four cases. In contrast, internal mammary artery grafts were not contracted by ach; in four of 12 segments a dilatation was observed, whereas five of 20 aortocoronary venous graft segments showed a slight reduction in lumen diameter after the highest ach close applied. The vasoconstricting effect showed of ach was reversed by intracoronary nitroglycerin.
By using ach as an indicator of endothelial dysfunction it is conclused that the internal mammary artery grafts maintained an intact endothelial function after surgery, whereas the coronary artery segments showed an impaired endothelium-dependent vasodilatation. Some of the venous graft segments reacted as coronary arteries did with a less pronounced cholinergic vasoconstriction. This in vivo study supports the observation of a functional superiority of internal mammary artery over saphenous vein coronary grafts.
Key Words: Acetylcholine • vascular tone • coronary artery • aortocoronary venous graft • internal mammary artery graft
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