Abstract 13060: Prognostic Significance of Arterial Stiffness and Vascular Calcification in Patients With Coronary Artery Disease After Percutaneous Coronary Intervention

Abstract

Introduction: Coronary atherosclerosis is the pathophysiologic background of coronary artery disease (CAD). Arterial stiffness and vascular calcification significantly contribute to coronary atherosclerosis progression. Hypothesis: Arterial stiffness and serum osteoprotegerin (OPG) levels are associated with cardiovascular prognosis in patients with stable CAD after percutaneous coronary intervention (PCI). Methods: We followed up prospectively (median time 40months), 220 consecutive subjects with stable CAD (mean age: 62±9years) after successful PCI. Carotid femoral pulse wave velocity (PWV) was measured as an index of arterial stiffness. OPG plasma levels were measured as a biomarker of vascular calcification. The primary end point was the composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke or hospitalization for cardiovascular causes. Results: During the follow-up period 66 patients presented the primary composite endpoint. There was no difference in age, body mass index, female gender, diabetes and hypertension, between the subjects who presented the primary end point compared to subjects free of cardiovascular events (p=NS for all). Subjects who present the primary end point compared to those free of cardiovascular events were more often active smokers (p=0.03), had higher prevalence of 3 vessels CAD (p=0.03) and lower left ventricle ejection fraction (p=0.07). Importantly, subjects who present the primary end point, compared to subjects free of cardiovascular events, had significantly increased PWV (9.45±2.48m/sec vs. 8.50±1.90m/sec, p=0.005) and OPG levels (4.21±2.19pmol/L vs. 3.12±1.74pmol/L, p=0.002). Finally, a cox regression model revealed that the primary end point was significantly associated with PWV (Hazard ratio=1.34 95%CI: 1.09-1.64, p=0.005) and OPG levels (Hazard ratio=1.23 95%CI: 1.039-1.45, p=0.02) even after adjustment for confounders such as age, sex, smoking habits, ejection fraction, extent of CAD, hypertension and diabetes. Conclusions: Increased arterial stiffness and vascular calcification, estimated by serum osteoprotogerin levels, are significant determinants of adverse cardiovascular events in subjects with established CAD after PCI.