Key result
Abnormal reserve pulse pressure linked to ~147% higher death risk in suspected CAD with normal MPI.
Why the study?
Does abnormal reserve pulse pressure predict death in symptomatic patients without known CAD but normal exercise myocardial perfusion imaging?
Cohort (n=4,269)
Does abnormal reserve pulse pressure predict death in symptomatic patients without known CAD but normal exercise myocardial perfusion imaging?
Hazard Ratio: 2.47 (95% CI 1.8–3.3)
In symptomatic patients with normal myocardial perfusion imaging, an abnormal reserve pulse pressure during exercise independently predicts higher mortality and improves risk stratification.
May aid risk stratification after normal MPI; extends observational data but leaves open therapeutic implications.
AIMS: To evaluate the incremental prognostic value of reserve-pulse pressure (reserve-PP: exercise-PP minus rest-PP) to standard risk factors among patients with suspected coronary artery disease (CAD) but normal exercise myocardial perfusion imaging (MPI). METHODS AND RESULTS: We studied 4269 consecutive symptomatic patients without known CAD who were referred for exercise MPI but had normal MPI results (mean age 58 ± 12 years, 56% females, 84% referred for evaluation of chest pain or dyspnoea, 95% with intermediate pretest likelihood of CAD). There were 202 deaths over 5.1 ± 1.4 years of follow-up. Reserve-PP was abnormal (<44 mmHg increase in PP from rest) in 1894 patients (44%). Patients with an abnormal reserve-PP had a higher risk of death compared with patients with normal reserve-PP [hazard ratio (HR): 2.47, 95% CI, 1.8-3.3]. In multivariable models adjusting for age, sex, ejection fraction, medications, heart rate recovery, Duke treadmill score (DTS), and rest-PP, each 10 mmHg lower reserve-PP was associated with a 20.6% increase in risk-adjusted mortality (adjusted HR 0.83, 95% CI 0.76-0.91). Models incorporating reserve-PP significantly reclassified risk compared with models without these parameters (net reclassification index 14.3%, P = 0.0007; integrated discrimination index 0.69, P = 0.01). CONCLUSION: In patients without a history of CAD and a normal MPI, an abnormal reserve-PP identified and reclassified those at higher risk of death independent of known risk factors and DTS.
No takes yet. Share an insight, caveat, or question.
Thomas et al. (2013) conducted a cohort in suspected coronary artery disease (CAD) with normal exercise myocardial perfusion imaging (MPI) (n=4,269). Abnormal reserve-pulse pressure vs. Normal reserve-pulse pressure was evaluated on death (HR 2.47, 95% CI 1.8-3.3). In patients with suspected CAD and normal myocardial perfusion imaging, an abnormal reserve-pulse pressure was associated with a higher risk of death (HR 2.47; 95% CI 1.8-3.3).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: