Non-invasive vascular measures as prognostic predictors for older patients with non-ST elevation acute coronary
Valerie J Dirjayanto1,2, Graziella Pompei1,3, Francesca Rubino1,4
1Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Insights
In older patients with non-ST elevation acute coronary syndrome (NSTEACS), endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness did not prove to be strong predictors of long-term adverse cardiac events. Further research is needed to identify reliable prognostic markers for this vulnerable population.
Area of Science:
- Cardiology
- Geriatrics
- Vascular Medicine
Background:
- Older adults with non-ST elevation acute coronary syndrome (NSTEACS) face a high risk of adverse cardiac events.
- Predictive markers for long-term outcomes in this demographic remain insufficient.
- This study evaluated non-invasive vascular measures for prognostic value in elderly NSTEACS patients.
Purpose of the Study:
- To assess the long-term prognostic significance of endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness in older NSTEACS patients.
- To determine if these non-invasive measures can predict major adverse cardiovascular events (MACE) in this population.
Main Methods:
- A multicentre cohort study (NCT01933581) included NSTEACS patients aged 75 years and older.
- Endothelial function was measured by the logarithm of reactive hyperemia index (LnRHI).
- Carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cfPWV) assessed vascular structure and stiffness.
- Long-term outcomes included MACE (death, reinfarction, urgent revascularization, stroke/TIA, bleeding).
Main Results:
- No significant association was found between LnRHI and MACE or mortality.
- CIMT did not show a statistically significant difference in MACE.
- cfPWV also did not demonstrate prognostic significance for MACE in this cohort.
Conclusions:
- Endothelial function, CIMT, and vascular stiffness are not strong prognostic predictors in older NSTEACS patients.
- Current non-invasive vascular measures are insufficient for predicting long-term adverse events in this specific patient group.
Background:
Adverse cardiac events are common in older patients with non-ST elevation acute coronary syndrome (NSTEACS), yet prognostic predictors are still lacking. This study investigated the long-term prognostic significance of non-invasive measures including endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness in older NSTEACS patients referred for invasive treatment.
Methods:
NSTEACS patients aged 75 years and older recruited to a multicentre cohort study (NCT01933581) were assessed for baseline endothelial function using endoPAT logarithm of reactive hyperemia index (LnRHI), CIMT using B-mode ultrasound, and vascular stiffness using carotid-femoral pulse wave velocity (cfPWV). Long-term outcomes included major adverse cardiovascular events (MACE), a composite of death, reinfarction, urgent revascularization, stroke/transient ischemic attack, and significant bleeding.
Results:
Recruitment resulted in 214 patients assessed for LnRHI, 190 patients assessed for CIMT and 245 patients assessed for cfPWV. For LnRHI group (median follow-up 4.73 years [IQR: 1.41-5.00]), Cox regression analysis revealed a trend towards increased risk of MACE (HR: 1.24 [95% CI: 0.80-1.93]; P = 0.328) and mortality (HR: 1.49 [95% CI: 0.86-2.59]; P = 0.157), but no significance was reached. No difference for other components of MACE was found. For CIMT group (median follow up 4.74 years [IQR: 1.55-5.00]), no statistically significant difference in MACE was found (HR: 0.92 [95% CI: 0.53-1.59]; P = 0.754). Similarly, for cfPWV group (median follow-up 4.96 years [IQR: 1.55-5.00]), results did not support prognostic significance (for MACE, HR: 0.95 [95% CI: 0.65-1.39]; P = 0.794).
Conclusion:
Endothelial function, CIMT and vascular stiffness were proven unsuitable as strong prognostic predictors in older patients with NSTEACS.
Clinical Trial Registration:
NCT01933581.
More Related Videos
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Acute Coronary Syndrome V: Nursing Management