Prognostic Significance of Upstroke Time per Cardiac Cycle in Coronary Artery Disease Patients With Normal Ankle-Brachial Index

Q: What are the key findings of this study?

Prolonged upstroke time (≥180 ms) was associated with an increased risk of unplanned coronary revascularization for de novo lesions (HR 1.84) in CAD patients with normal ABI.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease with normal ankle-brachial index (n=713). Intervention: Prolonged upstroke time (≥180 ms) vs. Normal upstroke time (<180 ms). Primary outcome: Unplanned coronary revascularization for de novo lesions (HR 1.84, 95% CI 1.12-3.00, p=0.015).

Q: What does this research mean for the field?

Upstroke time per cardiac cycle has prognostic significance for outcomes after percutaneous coronary intervention in coronary artery disease patients with a normal ankle-brachial index. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Joh Akama; Takeshi Shimizu; Yuuki Muto; Yu Sato; Takatoyo Kiko; Akihiko Sato; Tomofumi Misaka; Takashi Kaneshiro; Akiomi Yoshihisa; K Nakazato; Takafumi Ishida; Yasuchika Takeishi

doi:10.1253/circrep.cr-26-0057

April 14, 2026Circulation ReportsOpen Access

Prognostic Significance of Upstroke Time per Cardiac Cycle in Coronary Artery Disease Patients With Normal Ankle-Brachial Index

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Key result

Prolonged upstroke time is linked to ~84% more unplanned revascularization for de novo lesions.

HR 1.84
95% CI 1.12-3.00
P=0.015
n=713

Figures

Why the study?

Whether upstroke time predicts outcomes after PCI in patients with normal ankle-brachial index remains unclear.

Does prolonged upstroke time predict unplanned coronary revascularization for de novo lesions in CAD patients with normal ABI undergoing PCI?

Key Points

To determine whether ankle pulse volume recording upstroke time predicts subsequent coronary events following percutaneous coronary intervention in patients with a normal ankle-brachial index.
Analyzed 713 patients (mean age 67.5±11.7 years; 81.1% men) from a retrospective percutaneous coronary intervention registry at Fukushima Medical University Hospital with bilateral ankle-brachial index 0.90–1.40 and no atrial fibrillation or known severe aortic stenosis.
Measured upstroke time from brachial-ankle pulse volume recordings using an automated device, categorizing values as normal (<180 ms) or prolonged (≥180 ms), over a mean follow-up of 1,943 days.
Evaluated unplanned coronary revascularization for de novo lesions using Cox proportional hazards models adjusting for age, sex, multivessel disease, hypertension, diabetes mellitus, and dyslipidemia.
Unplanned coronary revascularization for de novo lesions occurred in 82 patients (11.5%) and occurred at higher rates among patients with prolonged upstroke time (log-rank P=0.022).
Prolonged upstroke time independently predicted unplanned revascularization for de novo lesions (adjusted HR 1.84, 95% CI 1.12–3.00; P=0.015).
Each 10-ms increase in upstroke time was independently associated with unplanned revascularization for de novo lesions (HR 1.10, 95% CI 1.01–1.19; P=0.020).

Study Design

Type

Observational (n=713)

Multicenter

No

Structured PICO

Does prolonged upstroke time predict unplanned coronary revascularization for de novo lesions in CAD patients with normal ABI undergoing PCI?

P

Population

713 patients with coronary artery disease and normal ankle-brachial index who underwent percutaneous coronary intervention, followed for a mean of 1,943 days.

E

Exposure

Prolonged upstroke time (UT) ≥180 ms measured from brachial-ankle pulse volume recordings

C

Comparator

Normal upstroke time (UT) <180 ms

O

Outcome

Unplanned coronary revascularization for de novo lesions (defined as PCI or coronary artery bypass grafting for new lesions; excluding staged PCI and target lesion revascularization)hard clinical

Main Result

Hazard Ratio: 1.84 (95% CI 1.12–3)

p-value: p=0.015

Prolonged upstroke time is an independent predictor of future unplanned coronary revascularization for de novo lesions in CAD patients with normal ABI after PCI.

Limitations

Single-center retrospective design
Residual confounding
Lack of body-size adjustment for UT
Incomplete assessment for LEAD (reliance on ABI alone)
Limited PCI variables
No longitudinal data on risk factor control or medication intensity
single-center retrospective design
residual confounding
lack of body-size adjustment for UT
incomplete assessment for LEAD (reliance on ABI alone)
limited PCI variables
no longitudinal data on risk factor control or medication intensity

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Discussion

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Implication

Should not yet change practice in CAD patients with normal ABI; hypothesis-generating for upstroke time in post-PCI risk stratification.

Abstract

Background: Whether upstroke time (UT) predicts outcomes after percutaneous coronary intervention (PCI) in patients with normal ankle-brachial index (ABI) remains unclear. Methods and Results: In a registry, 713 patients with ABI 0.90-1.40 and no atrial fibrillation or known severe aortic stenosis were analyzed. UT was measured from brachial-ankle pulse volume recordings and classified as <180 or ≥180 ms. Prolonged UT was associated with high risk of unplanned revascularization for de novo lesions (adjusted hazard ratio 1.84, P=0.015). Conclusions: UT prolongation indicates risk of de novo revascularization after PCI despite normal ABI.

Cite This Study

Akama et al. (2026) conducted an observational in Coronary artery disease with normal ankle-brachial index (n=713). Prolonged upstroke time (≥180 ms) vs. Normal upstroke time (<180 ms) was evaluated on Unplanned coronary revascularization for de novo lesions (HR 1.84, 95% CI 1.12-3.00, p=0.015). Prolonged upstroke time (≥180 ms) was associated with an increased risk of unplanned coronary revascularization for de novo lesions (HR 1.84) in CAD patients with normal ABI.

synapsesocial.com/papers/69e1cdc45cdc762e9d85715e https://doi.org/10.1253/circrep.cr-26-0057

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Prognostic Significance of Upstroke Time per Cardiac Cycle in Coronary Artery Disease Patients With Normal Ankle-Brachial Index

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

Prognostic Significance of Upstroke Time per Cardiac Cycle in Coronary Artery Disease Patients With Normal Ankle-Brachial Index

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

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