Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction
BackgroundHigh aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST‐elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far. Methods and Result...
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| Format: | Article |
| Language: | English |
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Wiley
2017-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.005590 |
| _version_ | 1819178443313512448 |
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| author | Hans‐Josef Feistritzer Gert Klug Sebastian J. Reinstadler Martin Reindl Lea Niess Timo Nalbach Christian Kremser Agnes Mayr Bernhard Metzler |
| author_facet | Hans‐Josef Feistritzer Gert Klug Sebastian J. Reinstadler Martin Reindl Lea Niess Timo Nalbach Christian Kremser Agnes Mayr Bernhard Metzler |
| author_sort | Hans‐Josef Feistritzer |
| collection | DOAJ |
| description | BackgroundHigh aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST‐elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far. Methods and ResultsThis prospective observational study included 160 consecutive patients with first acute ST‐elevation myocardial infarction. Aortic pulse wave velocity (PWV) was measured 2 (interquartile range 2‐4 days) days after infarction using cardiac magnetic resonance imaging. The primary end point was defined as a composite end point of major adverse cardiac and cerebrovascular events (MACCE) comprising death, nonfatal myocardial reinfarction, new congestive heart failure, and stroke. During a median follow‐up of 1.2 years (interquartile range 1.0‐3.1 years), 19 (12%) MACCE events occurred. Kaplan‐Meier analysis showed a significantly lower MACCE‐free survival in patients with high PWV (PWV >7.3 m/s, log‐rank P=0.003). Multivariable Cox regression analysis revealed PWV >7.3 m/s to be an independent predictor of MACCE after adjustment for age, sex, mean blood pressure, N‐terminal pro–brain natriuretic peptide levels, presence of multivessel disease, and left ventricular stroke volume (hazard ratios ≥3.5; 95% confidence interval 1.4‐13.3; all P≤0.018). In reclassification analysis the addition of PWV to a risk model comprising major clinical prognostic parameters led to a net reclassification improvement of 0.11 (95% confidence interval 0.06‐0.17; P<0.001). ConclusionsIncreased aortic stiffness is an independent predictor of MACCE after acute ST‐elevation myocardial infarction. Moreover, the assessment of aortic stiffness in addition to classical risk factors significantly improved early risk stratification. |
| first_indexed | 2024-12-22T21:42:38Z |
| format | Article |
| id | doaj.art-fbc010c129ea498397a44b9efb91efe7 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:42:38Z |
| publishDate | 2017-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-fbc010c129ea498397a44b9efb91efe72022-12-21T18:11:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-09-016910.1161/JAHA.117.005590Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial InfarctionHans‐Josef Feistritzer0Gert Klug1Sebastian J. Reinstadler2Martin Reindl3Lea Niess4Timo Nalbach5Christian Kremser6Agnes Mayr7Bernhard Metzler8University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Radiology, Medical University of Innsbruck, AustriaUniversity Clinic of Radiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaBackgroundHigh aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST‐elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far. Methods and ResultsThis prospective observational study included 160 consecutive patients with first acute ST‐elevation myocardial infarction. Aortic pulse wave velocity (PWV) was measured 2 (interquartile range 2‐4 days) days after infarction using cardiac magnetic resonance imaging. The primary end point was defined as a composite end point of major adverse cardiac and cerebrovascular events (MACCE) comprising death, nonfatal myocardial reinfarction, new congestive heart failure, and stroke. During a median follow‐up of 1.2 years (interquartile range 1.0‐3.1 years), 19 (12%) MACCE events occurred. Kaplan‐Meier analysis showed a significantly lower MACCE‐free survival in patients with high PWV (PWV >7.3 m/s, log‐rank P=0.003). Multivariable Cox regression analysis revealed PWV >7.3 m/s to be an independent predictor of MACCE after adjustment for age, sex, mean blood pressure, N‐terminal pro–brain natriuretic peptide levels, presence of multivessel disease, and left ventricular stroke volume (hazard ratios ≥3.5; 95% confidence interval 1.4‐13.3; all P≤0.018). In reclassification analysis the addition of PWV to a risk model comprising major clinical prognostic parameters led to a net reclassification improvement of 0.11 (95% confidence interval 0.06‐0.17; P<0.001). ConclusionsIncreased aortic stiffness is an independent predictor of MACCE after acute ST‐elevation myocardial infarction. Moreover, the assessment of aortic stiffness in addition to classical risk factors significantly improved early risk stratification.https://www.ahajournals.org/doi/10.1161/JAHA.117.005590aortic stiffnesscardiac magnetic resonanceprognosispulse wave velocityST‐elevation myocardial infarction |
| spellingShingle | Hans‐Josef Feistritzer Gert Klug Sebastian J. Reinstadler Martin Reindl Lea Niess Timo Nalbach Christian Kremser Agnes Mayr Bernhard Metzler Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic stiffness cardiac magnetic resonance prognosis pulse wave velocity ST‐elevation myocardial infarction |
| title | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
| title_full | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
| title_fullStr | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
| title_full_unstemmed | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
| title_short | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
| title_sort | prognostic value of aortic stiffness in patients after st elevation myocardial infarction |
| topic | aortic stiffness cardiac magnetic resonance prognosis pulse wave velocity ST‐elevation myocardial infarction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.005590 |
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