Arterial stiffness for predicting major adverse cardiovascular events in post-infarcted patients

Abstract

Abstract Introduction According to recent 2021 ESC prevention guidelines arterial stiffness (aortic pulse wave velocity –PWV, augmentation index - Aix) predicts future major adverse cardiovascular events (MACE). Both parameters have a prognostic relevance in different patient population (hypertension, diabetes, chronic kidney disease), however in post-infarcted, very high cardiovascular risk population the exact prognostic value for PWV and Aix needs to be clarify. Purpose We evaluated PWV and Aix cut-off values for MACE prediction and validated the prognostic relevance of high stiffness parameters in post-infarcted patients. Methods Oscillometric based pulse wave analysis method (Arteriograph) was applied for calculating arterial stiffness. We aimed to evaluate PWV and Aix cut-off values for predicting MACE (comprising all-cause death, non-fatal myocardial infarction, ischemic stroke, hospitalization for heart failure and coronary revascularization) in post-infarcted, very high cardiovascular risk patient population. 114 patients (89 male, average age: 62,5±10,5 years) were investigated in this long term, median 16,2 (IQR: 6,5-17,4) years follow-up study. Results Strong, significant correlation was found between PWV and Aix values (Spearman rho: 0,648, p<0,001). Totally 140 MACE events occurred during the 16,2 years follow-up period. Optimized PWV and Aix cut-off values for MACE prediction were calculated (PWV: 9,84 m/s, AUC: 0,754 (95% CI: 0,66-0,85), p<0,001; Aix: 34,8 %, AUC: 0,67 (95% CI: 0,57-0,77), p<0,05) by ROC analysis (Figure 1.). Kaplan-Meier analysis in both parameters showed a significantly lower event-free survival in case of high PWV and Aix values (p<0,05; Figure 2.). Multivariate Cox regression analysis revealed PWV and Aix as an independent predictor of MACE (PWV HR: 1,32 (95% CI: 1,15-1,53), p<0,001; Aix HR:1,04 (95% CI: 1,01-1,08), p<0,05). Conclusions Arterial stiffness, particularly elevated PWV predicts MACE in post-infarcted, very high cardiovascular risk patient population. All these findings emphasize the clinical relevance for the future measurement of arterial stiffness might contribute to improve individual risk stratification in patients after myocardial infarction.ROC analysis for the prediction of MACEKaplan-Meier curves for MACE