Invasively measured aortic pulse pressure and long-term prognosis in patients undergoing invasive coronary angiography: a prospective observational study

BACKGROUND: Although the invasive measurement of intra-arterial pressure is considered the gold standard, it is not feasible for routine clinical practice. This study aimed to investigate the prognostic value of invasively measured aortic pulse pressure (aPP) in patients undergoing invasive coronary angiography (ICA). METHODS: A total of 1110 patients who underwent ICA (mean age 65 years, 35.5% female) were prospectively enrolled. Just before ICA, aortic pressures were measured using a pigtail catheter positioned 3 cm above the aortic valve. Major adverse cardiovascular events (MACE), a composite of cardiac death, nonfatal acute myocardial infarction, coronary revascularization, and ischemic stroke, were assessed during clinical follow-up after ICA. RESULTS: During a median follow-up of 6.3 years (interquartile range, 2.8-8.9 years), there were 153 cases of MACE (13.8%). Patients with MACE had a higher aPP compared to those without MACE (83.0 ± 25.3 vs. 62.9 ± 18.1 mmHg; P < 0.001). Kaplan-Meier survival analysis demonstrated that a higher aPP (≥78 mmHg) was associated with an increased risk of MACE (log-rank P < 0.001). Multiple Cox regression analysis revealed that an increase in aPP by 10 mmHg was significantly associated with a higher risk of MACE, even after adjusting for potential confounders (hazard ratio, 1.68; 95% confidence interval, 1.49-1.82; P < 0.001). CONCLUSION: Invasively measured aPP is a strong and independent predictor of long-term cardiovascular outcomes in patients undergoing ICA. aPP could be a valuable addition to current risk assessment tools in this high-risk population.