Author + information
- Marcelo Gomes Lobo1,
- Thiago Dipp2,
- Ivan Petry3,
- Karine Schmidt4,
- Marcia Moura5,
- Cristina Gazeta6,
- Mariana Azeredo7,
- Yan Wang8,
- Renato Lopes9,
- Lucia Pellanda10,
- Carlos Gottschall11 and
- Keyvan Karimi Galougahi12
- 2St George's Hospital, London
- 3University of California San Francisco Medical Center and San Francisco VA
- 4Herlev & Gentofte Hospital, University of Copenhagen, Denmark
- 5Bispebjerg University Hospital, Copenhagen, Denmark
- 6Herlev & Gentofte Hospital, University of Copenhagen, Denmark
- 7Herlev & Gentofte Hospital, University of Copenhagen, Denmark
- 8Department of Cardiology, Affiliated Hospital of Zunyi Medical College
- 9Duke University Medical Center, Durham, North Carolina, United States
- 10Interventional Cardiology, Sandro Pertini Hospital, Rome
- 11Interventional Cardiology, Sandro Pertini Hospital, Rome
- 12Columbia University Medical Center, Porto Alegre, Rio Grande do Sul, Brazil
Periodontal disease has been linked to increased risk of myocardial infarction, but a causal association has not been demonstrated. The objective of the present study is to evaluate the impact of a periodontal treatment on flow-mediated vasodilation (FMD) of patients with a recent ST-elevation myocardial infarction (STEMI).
Randomized controlled parallel clinical trial (NCT02543502). Patients with STEMI and periodontal disease admitted between August 2012 and January 2015 were included in the study. Patients were screened during the index hospitalization for STEMI, and randomized 2 weeks later to periodontal treatment or to the control group. The primary outcome was the variation of the brachial artery FMD from baseline to the 6-month follow-up, and the investigator doing this evaluation was blinded to treatment assignment. Secondary outcomes were cardiovascular events, adverse effects of the periodontal treatment and inflammatory profile (circulating IL-1β, IL-6 and IL-10). A generalized estimative equation with the Bonferroni correction was applied to compare intergroup FMD variation.
Baseline characteristics were balanced between patients in the intervention (n=24) and control group (n=24), but family history of CAD that was more common in the control group. Periodontal treatment significantly improved indices of periodontal health, like probing depth, insertion loss, bleeding on probing and visible plaque. There was a significant FMD improvement in the intervention group (3.05%; p=0.01), but not in the control group (-0.29%; p=0.79) (p=0.03 for the intergroup comparison). There were no differences in clinical events and circulating cytokines in both groups, and periodontal treatment was not associated with any adverse events.
This is the first study showing that treatment of periodontal disease improves endothelial function of patients with a recent myocardial infarction. Larger trials are now needed to assess the impact of periodontal treatment on subsequent clinical outcomes.
CORONARY: Acute Myocardial Infarction