Key result
High invasive aortic pulse pressure linked to ~42% higher odds of CMEID in non-obstructive CAD.
Why the study?
Non-invasive studies show pulse pressure relates inversely to coronary microvascular function in non-obstructive CAD, but whether invasive aortic pulse pressure associates with CMED or CMEID was unknown.
Does high invasive aortic pulse pressure predict coronary microvascular endothelial-independent dysfunction and mortality in patients with non-obstructive CAD?
Cohort (n=1,894)
No
Does high invasive aortic pulse pressure predict coronary microvascular endothelial-independent dysfunction and mortality in patients with non-obstructive CAD?
Odds Ratio: 1.42 (95% CI 1.13–1.78)
Absolute Event Rate: 40.9% vs 25.2%
p-value: p=0.003
In patients with non-obstructive CAD, high invasive aortic pulse pressure is an independent predictor of coronary microvascular endothelial-independent dysfunction and long-term all-cause mortality.
High aortic pulse pressure was associated with CMEID and mortality in non-obstructive CAD; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: Pulse pressure (PP), a raw index of arterial stiffness, is inversely related to coronary microvascular function, even among patients with non-obstructive coronary artery disease (CAD), as per non-invasive studies. We aimed to determine whether invasive aortic PP is associated with coronary microvascular endothelial dysfunction (CMED) and/or coronary microvascular endothelial independent dysfunction (CMEID) in patients with non-obstructed CAD. METHODS: We retrospectively analysed a cohort of 1894 patients (mean age, 51.2 years; 1261 (66.6%) women) who presented with chest pain and non-obstructive CAD (angiographic stenosis <50%); coronary vasoreactivity was assessed in the mid-left anterior descending artery. The patients were classified based on whether aortic PP was high (≥50 mm Hg). CMEID was defined as abnormal coronary flow reserve (<2.5) or hyperaemic myocardial resistance (>2.0 mm Hg/cm/s), CMED was defined as abnormal acetylcholine-induced per cent change of coronary blood flow (≤50%). RESULTS: Patients with high aortic PP had a higher rate of CMEID than those with low aortic PP (40.9 vs 25.2%, p<0.001). Conversely, aortic PP was not associated with CMED. On multivariate analysis, high aortic PP was associated with CMEID occurrence (OR 1.42, 95% CI 1.13 to 1.78; p=0.003). On follow-up (median, 150 months), all-cause death was more frequent among patients with vs without high aortic PP (20.1% vs 7.3%, log-rank p<0.001) and HR was 2.08 (95% CI 1.34 to 3.32, p=0.002) on multivariate cox regression analysis. Furthermore, among patients with low aortic PP, CMEID was an independent risk factor for all-cause mortality (HR 2.04, 95% CI 1.01 to 4.16, p=0.048). CONCLUSION: In patients with non-obstructive CAD, invasive aortic PP was significantly associated with CMEID, but not with CMED. High aortic PP was an independent predictor of all-cause mortality, but CMEID was an independent risk factor in patients with low aortic PP.
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Park et al. (2022) conducted a cohort in Non-obstructive coronary artery disease (n=1,894). High aortic pulse pressure (≥50 mm Hg) vs. Low aortic pulse pressure (<50 mm Hg) was evaluated on Coronary microvascular endothelial independent dysfunction (CMEID) (OR 1.42, 95% CI 1.13 to 1.78, p=0.003). High invasive aortic pulse pressure in patients with non-obstructive CAD was independently associated with an increased risk of CMEID (OR 1.42) and long-term all-cause mortality.
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