Background. Periprocedural myocardial injury (PMI) is a most common complication of percutaneous coronary intervention (PCI). Microembolization and inflammation underlying PMI could lead to coronary microvascular dysfunction (CMD) and vice versa. Reactive hyperemia index (RHI) assessed by peripheral artery tonometry (PAT) has been considered as a noninvasive method to assess endothelial function and CMD, which could be useful to predict PMI. Methods. 268 patients suspected with stable coronary artery disease (CAD) and scheduled for elective coronary angiography were enrolled. RHI was measured by using the Endo-PAT2000™ device before angiography. The association among RHI, PMI, and cardiovascular events was further assessed. Results. In this cohort, 189 patients (70.5%) were diagnosed with CAD and 119 patients (44.4%) underwent drug-eluting stent (DES) implantation. Compared with patients without CAD, CAD patients had lower RHI (1.88 ± 0.55 vs. 2.02 ± 0.58, ). Patients with PMI had a lower RHI before angiography (1.75 ± 0.37 vs. 1.95 ± 0.50, ). Receiver operating characteristic curve analysis of RHI revealed an area under the curve (AUC) of 0.61, with a sensitivity of 62.7% and specificity of 50.0% to predict PMI. Moreover, we found that CAD patients with RHI ≤ 1.81 had a higher incidence of composite cardiac events after stenting (adjusted hazard ratio (HR) 3.31, 95% confidence interval (CI) 1.07–10.22, ). Conclusions. RHI assessment through PAT could be a promising method to predict PMI before the procedure. RHI is associated with increased risk of long-term adverse cardiac events after DES implantation.

中文翻译：

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外周动脉张力测量显示围手术期心肌损伤患者经皮冠状动脉介入治疗前内皮功能受损

背景。围手术期心肌损伤（PMI）是经皮冠状动脉介入治疗（PCI）最常见的并发症。PMI 的微栓塞和炎症可能导致冠状动脉微血管功能障碍 (CMD)，反之亦然。通过外周动脉张力计 (PAT) 评估的反应性充血指数 (RHI) 已被认为是评估内皮功能和 CMD 的一种无创方法，可用于预测 PMI。方法。268 名疑似患有稳定型冠状动脉疾病 (CAD) 并计划进行择期冠状动脉造影的患者入组。RHI 是在血管造影前使用 Endo-PAT2000™ 设备测量的。进一步评估了 RHI、PMI 和心血管事件之间的关联。结果. 在该队列中，189 名患者 (70.5%) 被诊断为 CAD，119 名患者 (44.4%) 接受了药物洗脱支架 (DES) 植入。与没有 CAD 的患者相比，CAD 患者的 RHI 较低（1.88 ± 0.55 vs. 2.02 ± 0.58，）。PMI 患者在血管造影前 RHI 较低（1.75 ± 0.37 vs. 1.95 ± 0.50，）。RHI 的受试者工作特征曲线分析显示曲线下面积 (AUC) 为 0.61，预测 PMI 的敏感性为 62.7%，特异性为 50.0%。此外，我们发现 RHI ≤ 1.81 的 CAD 患者在植入支架后复合心脏事件的发生率更高（调整后的风险比 (HR) 3.31，95% 置信区间 (CI) 1.07-10.22，）。 结论。通过 PAT 评估 RHI 可能是一种在手术前预测 PMI 的有前途的方法。RHI 与 DES 植入后长期不良心脏事件的风险增加有关。