Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions.

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.

[1]  S. Yusuf,et al.  Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. , 2000 .

[2]  Y Nakayama,et al.  Pulsatility of ascending aortic pressure waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty. , 2000, Circulation.

[3]  Thomas Weber,et al.  Arterial Stiffness, Wave Reflections, and the Risk of Coronary Artery Disease , 2004, Circulation.

[4]  J. Blacher,et al.  Impact of aortic stiffness on survival in end-stage renal disease. , 1999, Circulation.

[5]  J S Alpert,et al.  Myocardial infarction redefined--a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. , 2000, Journal of the American College of Cardiology.

[6]  C. Vlachopoulos,et al.  Genesis of the normal and abnormal arterial pulse. , 2000, Current problems in cardiology.

[7]  James D Cameron,et al.  Large artery stiffness predicts ischemic threshold in patients with coronary artery disease. , 2002, Journal of the American College of Cardiology.

[8]  Sanchez Me,et al.  Chronic coronary artery disease. , 2003 .

[9]  M E Safar,et al.  Arterial Wave Reflections and Survival in End-Stage Renal Failure , 2001, Hypertension.

[10]  Kozo Hirata,et al.  Benefits from angiotensin-converting enzyme inhibitor ‘beyond blood pressure lowering’: beyond blood pressure or beyond the brachial artery? , 2005, Journal of hypertension.

[11]  E J Topol,et al.  Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. , 1990, Circulation.

[12]  Sc Smith.  ACC/AHA guidelines for percutaneous coronary intervention , 2001 .

[13]  W. Nichols,et al.  McDonald's Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles , 1998 .

[14]  Cockcroft Dw,et al.  Prediction of Creatinine Clearance from Serum Creatinine , 1976 .

[15]  S. Yusuf,et al.  Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145-53. , 2000 .

[16]  K A Eagle,et al.  ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines)--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to revise the 1993 guidelines for percutaneous transluminal coro , 2001, Journal of the American College of Cardiology.

[17]  David J. Webb,et al.  Pulse‐Wave Analysis: Clinical Evaluation of a Noninvasive, Widely Applicable Method for Assessing Endothelial Function , 2002, Arteriosclerosis, thrombosis, and vascular biology.

[18]  Eckert,et al.  Validation of the OMRON R3 blood pressure self-measuring device through simultaneous comparative invasive measurements according to protocol 58130 of the German Institute for Validation. , 1997, Blood pressure monitoring.

[19]  J. Yoshikawa,et al.  Inflection point of ascending aortic waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty. , 2002, American journal of hypertension.

[20]  J. Blacher,et al.  Impact of Aortic Stiffness Attenuation on Survival of Patients in End-Stage Renal Failure , 2001, Circulation.

[21]  A. Mendez,et al.  Aortic Pressure Augmentation Predicts Adverse Cardiovascular Events in Patients With Established Coronary Artery Disease , 2005, Hypertension.

[22]  S. Laurent,et al.  Aortic Stiffness Is an Independent Predictor of Primary Coronary Events in Hypertensive Patients: A Longitudinal Study , 2002, Hypertension.

[23]  David O. Williams,et al.  ACC/AHA Guidelines for Percutaneous Coronary Intervention (Revision of the 1993 PTCA Guidelines)—Executive Summary , 2001 .

[24]  M E Safar,et al.  Improvement in Blood Pressure, Arterial Stiffness and Wave Reflections With a Very-Low-Dose Perindopril/Indapamide Combination in Hypertensive Patient: A Comparison With Atenolol , 2001, Hypertension.

[25]  D. Favarato,et al.  Chronic coronary artery disease , 1999 .

[26]  S. Verma,et al.  Endothelial function testing as a biomarker of vascular disease. , 2003, Circulation.

[27]  D. Webb,et al.  The influence of heart rate on augmentation index and central arterial pressure in humans , 2000, The Journal of physiology.

[28]  M. O'Rourke,et al.  Prospective Evaluation of a Method for Estimating Ascending Aortic Pressure From the Radial Artery Pressure Waveform , 2001, Hypertension.

[29]  M. Safar,et al.  Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with atenolol. , 2004, Journal of the American College of Cardiology.

[30]  M. Safar,et al.  Coronary ischemic disease, arterial stiffness, and pulse pressure. , 2004, American journal of hypertension.

[31]  M. Domanski,et al.  Determinants and prognostic information provided by pulse pressure in patients with coronary artery disease undergoing revascularization. The Balloon Angioplasty Revascularization Investigation (BARI). , 2001, The American journal of cardiology.

[32]  M. O'Rourke,et al.  Pulse wave analysis. , 2001, British journal of clinical pharmacology.

[33]  M. O'Rourke,et al.  Quantification of glyceryl trinitrate effect through analysis of the synthesised ascending aortic pressure waveform , 2002, Heart.