Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Hypertens. 2023 Mar 1;41(3):437-442. doi: 10.1097/HJH.0000000000003354. Epub 2022 Dec 27.
The prognostic value of changes in arterial stiffness has not been well evaluated. This study was conducted to investigate whether the change in arterial stiffness one month after percutaneous coronary intervention (PCI) affects the long-term cardiovascular prognosis.
A total of 405 patients (mean age, 62.0 ± 11.0 years; female sex, 27.7%) who underwent PCI with drug-eluting stent (DES) implantation was prospectively enrolled. The measurement of brachial-ankle pulse wave velocity (baPWV) was taken in all the study patient at the time of admission for index PCI. Major adverse cardiovascular event (MACE), a composite of cardiac death, nonfatal myocardial infarction, coronary revascularization and ischemic stroke, was assessed during clinical follow-up after index PCI.
During the median follow-up duration of 5.3 years (interquartile range. 2.9-7.9 years), there was 65 MACE (16.0%). There was no significant difference in clinical characteristics between patients with and without MACE except for higher prevalence of triple vessel disease in those with MACE. The baPWV value decreased at one month after index PCI (1560 ± 305 to 1530 ± 318 cm, P < 0.001). In multivariable cox regression analysis, the change of baPWV at one month was not associated with MACE occurrence ( P > 0.05). However, the change in systolic blood pressure (SBP)-adjusted baPWV (baPWV/SBP) at one month (increased vs . decreased) was significantly associated with MACE occurrence even after controlling for potential confounders (hazard ratio, 2.25; 95% confidence interval, 1.37-3.69; P = 0.001).
The baPWV/SBP change at one month was associated with long-term MACE in patients undergoing DES implantation. The results of this study suggest that baPWV/SBP changes at one month may be helpful in risk stratification of patients at a high coronary risk.
动脉僵硬度变化的预后价值尚未得到很好的评估。本研究旨在探讨经皮冠状动脉介入治疗（PCI）后 1 个月动脉僵硬度的变化是否影响长期心血管预后。
前瞻性纳入 405 例（平均年龄 62.0±11.0 岁；女性 27.7%）接受药物洗脱支架（DES）植入的 PCI 患者。所有研究患者在接受索引 PCI 时均进行肱踝脉搏波速度（baPWV）测量。在索引 PCI 后临床随访期间评估主要不良心血管事件（MACE），包括心源性死亡、非致死性心肌梗死、冠状动脉血运重建和缺血性卒中的复合终点。
在中位随访时间 5.3 年（四分位距 2.9-7.9 年）期间，发生 65 例 MACE（16.0%）。有 MACE 患者和无 MACE 患者的临床特征无显著差异，除 MACE 患者中三血管病变的患病率较高外。指数 PCI 后 1 个月时，baPWV 值降低（1560±305 至 1530±318 cm，P<0.001）。多变量 Cox 回归分析显示，1 个月时 baPWV 的变化与 MACE 发生无关（P>0.05）。然而，1 个月时收缩压校正后的 baPWV（baPWV/SBP）变化（增加与降低）与 MACE 发生显著相关，即使在控制潜在混杂因素后也是如此（危险比，2.25；95%置信区间，1.37-3.69；P=0.001）。
DES 植入后患者 1 个月时的 baPWV/SBP 变化与长期 MACE 相关。本研究结果提示，1 个月时的 baPWV/SBP 变化可能有助于高冠脉风险患者的风险分层。
