Impact of Aortic Stiffness on Further Cardiovascular Events in Patients with Chest Pain : A Invasive Study

Transcription

1 Impact of Aortic Stiffness on Further Cardiovascular Events in Patients with Chest Pain : A Invasive Study Cheol Ung Choi, Chang Gyu Park, Eun Bum Park, Soon Yong Suh, Jin Won Kim, Eung Ju Kim, Seung- Woon Rha, Hong Seog Seo, Dong Joo Oh, Young Moo Ro* Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea, Sejong General Hospital, Bucheon*

2 Background Traditional cardiovascular risk factors :Smoking, HTN, gender, lipid profile, DM, aging have been extensivley studied Recenlty, new strong risk factor of CV diasese :Arterial stiffness have been increasingly studied

3 Association with Arterial Stiffness and CVD (Evidence based) In cross-sectional study 1. Hypertensive patients, Blacher et.al. Hypertension. 1999;33: Subjects over 70 years old Meaume et. al. J of HTN. 2001;19: In longitudinal study 1. End-stage renal disease Blacher et. al. Circulation. 1999;99: Hypertensive patients Boutouyrie et. al. Hypertension. 2002;39: Generally healthy, community-dwelling older adult Kim et al. Circulation. 2005;111: In a general Danish population Hansen et. al. Circulation.2006:113:

4 In KOREA, Cross sectional study apwv :independent risk factor of CAD and CAD severity Lim HE, Park CG et. al. Blood pressure.2004;13: However, The predictive role of aortic stiffness for further CVD in Korean patients so far?

5 Objective To determine the impact of aortic stiffness on future CV events and mortality in chest pain

6 Subject and Study Design 1004 patients with chest pain CAG and apwv Exclusion :341 pts Inclusion: 663 pts Follow-up loss : 31 pts Follow-up duration < 12months:310 pts Mean follow-up: 35 months Medical record and phone survey New cardiovascular event

7 Primary Outcome Total mortality CVD mortality New CAD Stroke CHF

8 Measurement of apwv

9 Method New CV events definitions Fatal or nonfatal acute coronary syndrome or angina Fatal or nonfatal stroke events Hospitalization for CHF

10 Method 663 pts divided into tertiles according to apwv 1) Tertile 1 (n=222) : 9.29 m/s 2) Tertile 2 (n=199) : m/s 3) Tertile 3 (n=242) : m/s Lowest tertile as a reference group

11 Demographic and Clinical Characteristics apwv Tertile Total P-value (n=222) (n=199) (n=242) (n=663) Age 54.5± ± ± ±10.2 <0.001 Male 112(50.4) 89(44.7) 126(52.1) 327(49.3) Smoking 78(35.1) 77(38.7) 142(58.7) 297(44.8) <0.001 Hx of CVD 128(57.7) 133(66.8) 169(69.8) 430(64.9) Hx of HTN 110(49.5) 113(56.8) 145(59.9) 368(55.5) 0.073

12 Demographic and Clinical Characteristics apwv Tertile Total P-value (n=222) (n=199) (n=242) (n=663) Hx of DM 24(10.8) 39(19.6) 55(22.7) 118(17.8) SBP 131.8± ± ± ±22.4 <0.001 DBP 82.1± ± ± ± Pulse pressure 49.7± ± ± ±15.0 <0.001 MAP 98.6± ± ± ±

13 Prevalence of Clinical Events According to apwv apwv Tertile 9.29 m/s m/s m/s Total Diagnosis (n=222) (n=199) (n=242) (n=663) P New CVD 45(20.3%) 48(24.1%) 80(33.1%) 176(26.1%) New CAD 34(15.3%) 29(14.6%) 60(24.8%) 123(18.6%) New stroke 7(3.2%) 15(7.5%) 15(6.2%) 37(5.6%) New CHF 4(1.8%) 6(3.0%) 6(2.5%) 16(2.4%) Revascularization 6(2.7%) 5(2.5%) 17(7.0%) 28(4.2%) Death 1(0.5%) 2(1.0%) 4(1.7%) 7(1.1%) 0.447

14 dd ratio 2.5 Univariate Analysis between Risk Factors and New CV Events $ 0 Age>60 yrs Male Smoking HTN DM SBP DBP PP MAP Diagnosis apwv apwv : apwv (>12.31m/s), PP:pulse pressure, MAP : Mean artrial pressure Diagnosis: ACS, stable angina, stroke, peripheral vascular disease(+) : 95% CI = , * : 95% $:95%CI=

15 Multivariate Analysis between Risk Factors and New CV Events Odd 2 ratio $ # Age>60 yrs Male Smoking HTN DM SBP DBP PP MAP Diagnosis apwv apwv : apwv (>12.31m/s), PP:pulse pressure, MAP : Mean artrial pressure Diagnosis: ACS, stable angina, stroke, peripheral vascular disease(+) * : 95% $:95%CI= , #:95%CI=

16 Univariate Analysis between Risk Factors and New CAD apwv : apwv (>12.31m/s), PP:pulse pressure, MAP : Mean artrial pressure Diagnosis: ACS, stable angina, stroke, peripheral vascular disease(+) * : 95% CI= Odd 2.5 ratio * Age>60yrs Male Smoking HTN DM SBP DBP PP MAP Diagnosis apwv

17 Multivariate Analysis between Risk Factors and New CAD Odd ratio * # Age>60yrs Male Smoking HTN DM SBP DBP PP MAP Diagnosis apwv apwv : apwv (>12.31m/s), PP:pulse pressure, MAP : Mean artrial pressure Diagnosis: ACS, stable angina, stroke, peripheral vascular disease(+) * : 95% CI= , #:95%CI=

18 Impact of apwv on New CVD and New CAD Odd ratio Univariate analysis Multivariate analysis apwv<9.29 apwv >12.31 apwv >12.31 apwv<9.29 apwv >12.31 apwv >12.31 New CVD New CAD

19 All-cause Mortality, Cardiovascular Mortality, CHF and Stroke 7 deaths (1 fatal MI, 1fatal stroke, 2 fatal heart failure, and 3 cancer origin) occurred. apwv was not associated with All cause mortality (p=0.447) Cardiovascular mortality (p=0.686) New CHF(p=0.718) New stroke(p=0.128)

20 Summary 1.aPWV, Age(>60), Male, DM, CVD on initial presentation was independent risk factor for new CVD 2.aPWV, Male, DM, CVD on initial presentation was independent risk factor for new CAD

21 Conclusion Aortic stiffness (apwv) 1.Patients with chest pain 2.Independent risk factor for new CV events, CAD Measuring aortic stiffness in patients with chest pain 1.Identify patients at high risk of new CV event, CAD 2.Benefit from more aggressive diagnostic as well as therapeutic strategies.

22 Limitations First, our study is confined to patients with chest pain. Thus, our findings might not be suitable to apply to the general population. Second, impact of apwv on all-cause and CV mortality is not proved sufficiently. For further study on the impact of PWV on mortality, longer follow-up time will be needed.

23 Thank you for your attention

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