European Heart Journal Advance Access originally published online on September 23, 2005
European Heart Journal 2005 26(24):2657-2663; doi:10.1093/eurheartj/ehi504
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Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions
1Cardiology Department, Klinikum of the Kreuzschwestern, Grieskirchnerstrasse 42, 4600 Wels, Austria
2St Vincents' Clinic, UNSW, Sydney, Australia
3Hermesoft Biostatistics, Graz, Austria
Received 18 March 2005; revised 25 August 2005; accepted 2 September 2005; online publish-ahead-of-print 23 September 2005.
* Corresponding author. Tel: +43 7242 415 2215; fax: +43 7242 415 3992. E-mail address: thomas.weber{at}klinikum-wels.at
See page 2609 for the editorial comment on this article (doi:10.1093/eurheartj/ehi607)
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.
Key Words: Wave reflections • Coronary disease • Angioplasty • Arteries • Arteriosclerosis
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