Arterial stiffness index and blood pressure phenotypes in patients undergoing percutaneous coronary intervention: prognostic implications for ischemic and bleeding events
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Updated: Jun 28, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Byung Sik Kim1, Jong-Hwa Ahn2, Min Gyu Kang3
1Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.
Insights
Arterial stiffness, measured by brachial-ankle pulse wave velocity (baPWV), provides crucial prognostic information in patients undergoing percutaneous coronary intervention (PCI). Combining baPWV with hypertension status improves risk stratification for adverse clinical events after PCI.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Risk Stratification
Background:
- The prognostic value of arterial stiffness in hypertensive patients undergoing percutaneous coronary intervention (PCI) is not well-defined.
- Arterial stiffness assessment may offer additional insights beyond traditional hypertension status.
Purpose of the Study:
- To investigate whether arterial stiffness index, specifically brachial-ankle pulse wave velocity (baPWV), adds prognostic value in hypertensive patients post-PCI.
- To evaluate the combined prognostic impact of arterial stiffness and hypertension on clinical outcomes.
Main Methods:
- Brachial-ankle pulse wave velocity (baPWV) measured in 3,930 patients post-PCI.
- Primary outcome: net adverse clinical events (NACE) over 4 years.
- Patients stratified by hypertension status and baPWV levels (<1,891 cm/s vs. ≥1,891 cm/s).
Main Results:
- Arterial stiffness (baPWV phenotype) showed a stronger association with outcomes than hypertension status alone.
- An additive risk effect was observed when combining hypertension and high baPWV.
- Hypertensive patients with high baPWV had significantly higher risks of NACE, MACCE, and major bleeding compared to normotensive patients with low baPWV.
Conclusions:
- Arterial stiffness has significant additive prognostic implications in PCI patients.
- Integrating baPWV and hypertension phenotype enhances risk stratification for adverse events post-PCI.
Background:
The clinical implications of arterial stiffness in relation to hypertension remain unclear in patients undergoing percutaneous coronary intervention (PCI). This study aimed to determine whether the arterial stiffness index provides additional prognostic information regarding hypertension-related risks in this population.
Methods:
Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV) in 3,930 PCI patients before discharge. The primary outcome was net adverse clinical events (NACE), a composite of major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke) and major bleeding over 4 years. The patients were categorized into four groups based on hypertensive status and baPWV phenotype (< 1,891 vs. ≥ 1,891 cm/s).
Results:
Compared to hypertensive status, the baPWV phenotype showed a stronger association with clinical outcomes. Hypertensive status and baPWV phenotype showed an additive effect on risk stratification. The highest incidence rates of clinical events were observed in the hypertensives with high baPWV, followed by the normotensives with high baPWV, hypertensives with low baPWV, and normotensives with low baPWV groups. Specifically, the 4-year incidence of NACE was 14.8%, 12.4%, 7.1%, and 6.0%, respectively, and the corresponding incidences of MACCE were 12.7%, 9.5%, 6.2%, and 5.2%, respectively. The hypertensives with high baPWV group exhibited significantly higher risks for NACE (adjusted hazard ratio [aHR], 1.556; 95% confidence interval [CI], 1.132-2.138; P = 0.006), MACCE (aHR, 1.573; 95% CI, 1.113-2.223; P = 0.010), and major bleeding (aHR, 2.023; 95% CI, 1.029-3.978; P = 0.041) compared with the normotensive with low baPWV group. Findings were consistent across subgroups for NACE without significant interactions.
Conclusions:
Arterial stiffness exhibited additive prognostic implications in patients undergoing PCI. The combined use of the baPWV and hypertension phenotype may enhance post-PCI risk stratification for clinical events.
Trial Registration:
ClinicalTrials.gov Identifier: NCT04650529.
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