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Long-term prognostic implications of brachial-ankle pulse wave velocity in patients undergoing percutaneous coronary
Byung Sik Kim1, Jong-Hwa Ahn2, Jeong-Hun Shin1
1Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri-si, Republic of Korea.
Insights
Elevated brachial-ankle pulse wave velocity (baPWV) in patients after percutaneous coronary intervention (PCI) predicts long-term adverse clinical events, including ischemic and bleeding risks. This marker helps identify high-risk individuals for better management.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Clinical Cardiology
Background:
- The long-term clinical impact of arterial stiffness in high-risk patient populations is not fully understood.
- Brachial-ankle pulse wave velocity (baPWV) is a non-invasive measure of arterial stiffness.
Purpose of the Study:
- To assess the prognostic implications of baPWV in patients who have undergone percutaneous coronary intervention (PCI).
- To determine if baPWV can identify patients at higher risk for adverse clinical events post-PCI.
Main Methods:
- A real-world registry of 3,930 patients undergoing PCI was analyzed.
- Arterial stiffness was measured using baPWV before discharge.
- Patients were stratified into high- and low-baPWV groups (cut-off 1891 cm/s).
- Primary outcome was net adverse clinical events (NACE); secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE) and major bleeding over 4 years.
Main Results:
- A higher baPWV was linearly correlated with increased 4-year post-PCI clinical events.
- The high baPWV group exhibited a greater cumulative incidence of NACE, MACCE, and major bleeding.
- Multivariable analysis showed high baPWV significantly increased the risk of NACE (aHR 1.44), MACCE (aHR 1.40), and major bleeding (aHR 1.94).
Conclusions:
- Brachial-ankle pulse wave velocity is a significant independent predictor of long-term clinical outcomes in patients treated with PCI.
- baPWV effectively identifies high-risk phenotypes, encompassing both ischemic and bleeding events.
- These findings underscore the clinical utility of baPWV for risk stratification in post-PCI patients.
Objective:
The long-term clinical effect of arterial stiffness in high-risk disease entities remains unclear. The prognostic implications of brachial-ankle pulse wave velocity (baPWV) were assessed using a real-world registry that included patients who underwent percutaneous coronary intervention (PCI).
Methods:
Arterial stiffness was measured using baPWV before discharge. The primary outcome was net adverse clinical events (NACE), defined as a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or major bleeding. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE: a composite of all-cause death, non-fatal myocardial infarction, or non-fatal stroke), and major bleeding. The outcomes were assessed over a 4-year period.
Results:
Patients (n = 3,930) were stratified into high- and low-baPWV groups based on a baPWV cut-off of 1891 cm/s determined through time-dependent receiver operating characteristic curve analysis. baPWV was linearly correlated with 4-year post-PCI clinical events. The high baPWV group had a greater cumulative incidence of NACE, MACCE, and major bleeding. According to multivariable analysis, the high baPWV groups had a significantly greater risk of 4-year NACE (adjusted hazard ratio [HRadj]: 1.44; 95% confidence interval [CI]: 1.12-1.85; p = 0.004), MACCE (HRadj: 1.40; 95% CI: 1.07-1.83; p = 0.015), and major bleeding (HRadj: 1.94; 95% CI: 1.15-3.25; p = 0.012).
Conclusion:
In PCI-treated patients, baPWV was significantly associated with long-term clinical outcomes, including ischemic and bleeding events, indicating its value for identifying high-risk phenotypes.
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