Prognostic significance of arterial stiffness and osteoprotegerin in patients with stable coronary artery disease.

Abstract

Arterial stiffness and vascular calcification significantly contribute to coronary atherosclerosis progression. The prognostic value of increased arterial stiffness and vascular calcification in subjects with stable coronary artery disease (CAD) after percutaneous coronary intervention(PCI) is currently under question. We randomly enrolled 262 patients with stable CAD 1month after successful PCI. Carotid-femoral pulse wave velocity (PWV) was measured as a well-established index of central aortic stiffness. Osteoprotegerin (OPG) plasma levels were measured as a biomarker of vascular calcification. Patients were followed up prospectively up to 52months. The primary endpoint was the composite of death from cardiovascular causes, myocardial infarction, stroke or hospitalization for cardiovascular causes. During the follow-up period, 48 patients presented the primary composite endpoint. Subjects who presented the primary endpoint, compared to subjects free of cardiovascular events, had significantly increased PWV (9.45±2.19m/s vs 8.73±2.07m/s, P=.04) and OPG levels (4.21±2.19pmol/L vs 3.18±1.74pmol/L, P=.003). Survival analysis indicated that PWV predicted adverse cardiac events MACE (Hazard ratio=1.29 95%CI: 1.07-1.57, P=.008) independently from confounders such as age, sex, smoking habits, ejection fraction, extent of coronary artery disease, hypertension and diabetes mellitus. Interestingly, for every increase in pulse wave velocity by 1m/s, there is an anticipated increase in the risk of major adverse cardiovascular event (MACE) by 29%. These findings extend the current knowledge concerning the role of arterial stiffness as powerful biomarkers in cardiovascular disease. Measurement of PWV might have a role in ascertaining prognosis and managing treatment in patients with stable CAD after PCI.