Combination of pulse wave velocity with clinical factors as a promising tool to predict major adverse cardiac events after percutaneous coronary intervention

Background: The relationship between aortic stiffness and coronary artery disease has been proven. Logistic Clinical SYNTAX score (LogCSS), which combined the anatomical evaluation of coronary artery disease and three clinical factors (age, left ventricular ejection fraction, and creatinine clearance), showed improved predictive value for cardiovascular events in patients after percutaneous coronary intervention (PCI). The combination of pulse wave velocity (PWV) and clinical factors may show equivalent predictive value. Methods: Three hundred and seventy-six patients who were diagnosed with non-ST-segment elevation coronary syndrome (ACS) and showed at least one >= 50% angiographic stenosis in a major coronary artery were enrolled. The Clinical PWV score was calculated by assigning points to different levels of age, creatinine clearance, left ventricular ejection fraction, and carotid-femoral PWV (cfPWV). The points for cfPWV were determined based on the cutoff values of quintiles (model 1) or the relationship between cfPWV and SYNTAX scores (model 2). The predictive values of LogCSS and Clinical PWV score for 3-year major adverse cardiac events (MACE), which were defined as all-cause death, nonfatal myocardial infarction, and nonfatal target vessel revascularization, were analyzed in 298 patients undergoing PCI. Results: The Clinical PWV score based on model 2 demonstrated a similar predictive ability for 3-year MACE compared with LogCSS (AUC 0.72 vs. 0.75; p = 0.11). The AUC of LogCSS was significantly higher than the AUC of Clinical PWV score based on model 1 (AUC = 0.70, p = 0.03). Compared with cfPWV in isolation (AUC = 0.61), Clinical PWV score from model 2 showed significantly better predictive power (p = 0.03). Conclusion: Combination of PWV with age, creatinine clearance, and left ventricular ejection fraction appears to be a promising tool to predict MACE after PCI in patients with ACS. (C) 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.