Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction

• Published in: Journal of the American Heart Association Vol. 6; no. 9
• Main Authors: Feistritzer, Hans‐Josef, Klug, Gert, Reinstadler, Sebastian J., Reindl, Martin, Niess, Lea, Nalbach, Timo, Kremser, Christian, Mayr, Agnes, Metzler, Bernhard
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01.09.2017; Wiley
• Subjects: Aged; aortic stiffness; cardiac magnetic resonance; Chi-Square Distribution; Disease Progression; Female; Humans; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Original Research; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Pulse Wave Analysis; pulse wave velocity; Risk Factors; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - physiopathology; ST‐elevation myocardial infarction; Time Factors; Vascular Stiffness; aortic stiffness; pulse wave velocity; cardiac magnetic resonance; prognosis; ST‐elevation myocardial infarction
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.117.005590

Background High 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 Results This 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). Conclusions Increased 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.