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Background and Objectives
Pulse wave velocity (PWV) is an index of arterial stiffness and surrogate marker of subclinical cardiovascular disease. The clinical application of baPWV in patients with established coronary artery disease (CAD) remains unclear.
Subjects (Materials) and Methods
We evaluated that brachial-ankle pulse wave velocity (baPWV), a marker for arterial stiffness can be a risk stratification index to predict prognosis in patients with established CAD. We recruited the patients undergoing emergent or elective CAG and PCI for stable angina or acute coronary syndrome (non-ST-elevation and ST-elevation myocardial infarction, unstable angina). The main outcome measures were cardiovascular (CV) death, definite/probable stent thrombosis (ST), nonfatal myocardial infarction (MI), coronary revascularization (PCI or CABG) and a composite end point of ischemic events. PWV was determined using an automatic volume-plethysmographic device, form PWV/ABI.
In total, 925 patients were enrolled (Male 670, 72.4%) with median follow-up of 524 days. All patients received optimal antiplatelet therapy and proper coronary intervention. The higher baPWV was defined as a median baPWV of 1730 cm s-1 or more. The patients were diagnosed as ST elevation myocardial infarction (221, 23.0%), non ST elevation myocardial infarction (221, 23.9%), unstable angina (294, 31.8%), stable angina (189, 20.4%). The composite end points of the study at follow-up of 12 months were cardiovascular death, nonfatal myocardial infarction (MI), and coronary revascularization. At a 12-month follow-up, we found 61 total ischemic events (higher PWV 7.9% vs normal PWV 5.8% (p=0.211)), 18 cardiovascular deaths (2.0% vs 1.9% (p=0.964)), 5 nonfatal MIs (0.8% vs 0.4% (p=0.319)), 3 stent thrombosis (0.6% vs 0.3% (p=0.313)) and 45 target-vessel revascularizations (5.9% vs 4.2% (p=0.241)). In survival analysis, there was no significant difference between patient with higher baPWV and normal velocity. Multivariate analysis revealed that a higher baPWV was not significantly associated with poorer short-term prognosis (hazard ratio, 0.793; 95% confidence interval, 0.529-1.188) in established CAD patients.
baPWV, a marker for arterial stiffness, is not a risk stratification index for short-term prognosis in patients with established CAD patients. Routine use of PWV to predicting future cardiovascular events in patients with established CAD seems to be unnecessary.