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European Heart Journal Advance Access published online on September 23, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi504
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received March 18, 2005
Revised August 25, 2005
Accepted September 2, 2005

Clinical research

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

Thomas Weber 1*, Johann Auer 1, Michael F. O'Rourke 2, Erich Kvas 3, Elisabeth Lassnig 1, Gudrun Lamm 1, Nina Stark 1, Martin Rammer 1, and Bernd Eber 1

1 Cardiology Department, Klinikum of the Kreuzschwestern, Grieskirchnerstrasse 42, 4600 Wels, Austria
2 St Vincents' Clinic, UNSW, Sydney, Australia
3 Hermesoft Biostatistics, Graz, Austria

* To whom correspondence should be addressed.
Thomas Weber, E-mail: thomas.weber{at}klinikum-wels.at


  Abstract

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.

Keywords: Wave reflections; Coronary disease; Angioplasty; Arteries; Arteriosclerosis.
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