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European Heart Journal 1996 17(5):715-720;
Copyright © 1996 by the European Society of Cardiology.
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© The European Society of Cardiology

lschaemic heart disease

Endothelial dysfunction of the non-infarct related, angiographically normal, coronary artery in patients with an acute myocardial infarction

M. Heras, G. Sanz, E. Roig, F. Pérez-Villa, L. Recasens, A. Serra and A. Betriu

Department of cardiology, Hospital Clinic, University of Barcelona Barcelona, Spain

Received 29 August 1995; accepted 20 September 1995.

Correspondence: Dra Magda Heras, Hospital Clinic, Department of Cardiology, Villarroel 170, 08036 Barcelona, Spain.

Abstract

BACKGROUND: Patients with acute myocardial infarction and single-vessel disease may have early atherosclerosis in other angiographically normal coronary arteries.

METHODS: Coronary endothelial responses were analysed in 20 non-diabetic patients with an acute myocardial infarction and one-vessel discase. In an angiographically normal, non-infarct related, coronary artery serial acetylcholine doses of 10-6M, 10-5M and 10-4M and nitroglycerin 40 µg were infused over 3 min. The responses of the coronary vessel were measured with quantitative angiography. Coronary blood flow was also measured with a Doppler catheter in ll of the 20 patients.

RESULTS: Four patients showed a trend towards vasodilation during acetylcholine infusion in the proximal and distal segments: from 2·49 ± 0·23 mm to 2·95 ± 0·42 mm and 2·43 ± 0·56 mm to 2·81 ± 0·66 mm, respectively. Coronary vascular resistance decreased to 57 ± 4% (P=0·03). The other 16 patients presented vasoconstriction in the proximal and distal segments: 2·61 ± 0·75 mm to 2·03 ± 0·65 mm (P=0·0001), and 2·40 ± 0·58 to 1·81 ± 0·56 mm (P=0·0036), respectively. Nitroglycerin caused vasodilation in the proximal (2·69 ± 0·61 mm, P=0·017, ANOVA) and distal segments (2·48 ± 0±45 mm, P=0·009, ANOVA). Coronary vascular resistance increased to 141 ± 43% (P=0·;03) over the basal value in this group of patients.

CONCLUSION: Endothelial dysfunction of the epicardial and resistance vessels was found in angiographically normal coronary arteries of patients with one-vessel disease in 75% of this population.

Key Words: Endothelial dysfunction • myocardial infarction • coronary blood flow • angiographically normal coronary artery


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