Abstract
Risk stratification in secondary prevention has emerged as an unmet clinical need in order to mitigate the Number-Needed-to-Treat and make expensive therapies both clinically relevant and cost-effective. P wave indices reflect atrial conduction, which is a sensitive marker for inflammatory, metabolic, and pressure overload myocardial cell remodeling; the three stimuli are traditional mechanisms for adverse clinical evolution. Accordingly, we sought to investigate the predictive role of P-wave indices to estimate residual risk in patients with chronic coronary artery disease (CAD). The cohort included 520 post-Coronary Artery Bypass Grafting patients with a median age of 60 years who were followed for a median period of 1025 days. The primary endpoint was long-term all-cause death. Cubic spline model demonstrated a linear association between P-wave duration and incidence rate of long-term all-cause death (p = 0.023). P-wave >110ms was a marker for an average of 425 days shorter survival as compared with P-wave under 80ms (Logrank p = 0.020). The Cox stepwise regression models retained P-wave duration as independent marker (HR:1.37; 95%CI:1.05–1.79,p = 0.023). In conclusion, the present study suggests that P-wave measurement may constitute a simple, inexpensive and accessible prognostic tool to be added in the bedside risk estimation in CAD patients.
Highlights
In primary prevention setting, cardiovascular risk stratification is largely accepted as an approach to select individuals in whom medical attention must be intensified[1,2,3]
The study was designed to investigate the clinical value of using regular ECG for estimating the residual risk in individuals with stable coronary artery disease (CAD)
P-wave duration might reflect the electrical remodeling of the atria and is a predictor of death, atrial fibrillation or heart failure hospitalization in a large spectrum of patients[19],[20] including those post-coronary bypass grafting (CABG) [21]
Summary
Cardiovascular risk stratification is largely accepted as an approach to select individuals in whom medical attention must be intensified[1,2,3]. Similar to the primary spectrum, individuals at secondary prevention present a broad range of cardiovascular risk; worldwide guidelines classify them as a single high-risk category[4]. Recent evidences suggest the use of risk stratification as a strategy to mitigate the NumberNeeded-to-Treat and make expensive therapies both clinically relevant and cost-effective[5]. Risk stratification in secondary prevention has emerged as a paramount and unmet clinical need.
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