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Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary
Thomas Weber1, Johann Auer, Michael F O'rourke
1Cardiology Department, Klinikum of the Kreuzschwestern, Wels, Austria. thomas.weber@klinikum-wels.at
Insights
Increased arterial wave reflections, measured by augmentation index corrected for heart rate (AIx@75), predict cardiovascular events after percutaneous coronary interventions (PCIs). Higher AIx@75 levels indicate a greater risk of death, myocardial infarction, and restenosis.
Area of Science:
- Cardiovascular Medicine
- Vascular Physiology
- Interventional Cardiology
Background:
- Arterial wave reflections are linked to coronary atherosclerosis and mortality.
- Prognostic value of arterial wave reflections post-percutaneous coronary intervention (PCI) requires further investigation.
Purpose of the Study:
- To prospectively evaluate the short- and long-term prognostic value of arterial wave reflections in patients undergoing PCI.
Main Methods:
- Non-invasive quantification of arterial wave reflections (AIx@75) using applanation tonometry and transfer function.
- Analysis of 262 patients undergoing PCI with a 2-year follow-up.
Main Results:
- Increasing tertiles of AIx@75 correlated with higher rates of the primary endpoint (death, MI, restenosis).
- AIx@75 independently predicted total mortality, myocardial infarction, and combined death/MI.
- AIx@75 provided prognostic value beyond traditional risk factors and medications.
Conclusions:
- Elevated arterial wave reflections are independently associated with increased risk of severe cardiovascular events in patients post-PCI.
Aims:
Increased arterial wave reflections are associated with the presence and extent of coronary atherosclerosis and with cardiovascular mortality in selected populations. We prospectively evaluated their prognostic value in the short- and long-term following percutaneous coronary interventions (PCIs).
Methods And Results:
We non-invasively quantified wave reflections [expressed as augmentation index corrected for heart rate of 75 b.p.m. (AIx@75)] using applanation tonometry of the radial artery and a validated transfer function to obtain the corresponding aortic values in 262 patients undergoing PCI. During 2-year follow-up, 61 patients reached the primary endpoint [death, myocardial infarction (MI), and restenosis]. Increasing tertiles of Alx@75 were related to the rate of patients reaching the primary endpoint [15.2, 20 and 35.3%, respectively (P = 0.001)], as well as the secondary endpoints total mortality, myocardial infarction and death plus myocardial infarction (RR for the third vs. the first tertile 4.33, 3.25 and 3.46, respectively, P < 0.05). In a multivariable Cox-regression model, AIx@75 added prognostic value above and beyond clinical risk factors, angiographic variables, and medications (RR 1.8, 95%CI 1.18-2.76 per increasing AIx@75-tertile, P < 0.01).
Conclusion:
Increased arterial wave reflections are independently associated with an increased risk for severe short- and long-term cardiovascular events in patients undergoing PCI.
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