Bilateral difference versus mean brachial–ankle pulse wave velocity after percutaneous coronary intervention in patients with normal ankle–brachial indices

Bilateral brachial–ankle pulse wave velocity (baPWV) measurements provide a mean value and an absolute bilateral difference (ΔbaPWV). We compared their associations with 1-year major adverse cardiovascular events (MACE) after percutaneous coronary intervention. Among 1586 patients in two prospective multicenter stent registries, 1181 had bilateral ankle–brachial indices of 0.90–1.40 and complete baPWV measurements. Greater ΔbaPWV was associated with older age, higher body mass index, higher mean baPWV, and lower ankle–brachial index. During follow-up censored at 400 days, 61 patients experienced MACE, comprising all-cause death, myocardial infarction, stroke, or any revascularization. Crude incidence increased across ΔbaPWV tertiles (3.3%, 4.6%, and 7.7%; log-rank P = 0.013), but the adjusted highest-versus-lowest tertile comparison was nonsignificant (hazard ratio, 1.80; 95% confidence interval, 0.91–3.56; P = 0.092). Adding raw linear ΔbaPWV, but not mean baPWV, improved clinical-model fit (likelihood-ratio P = 0.026 and P = 0.439). The optimism-corrected C-index gain with ΔbaPWV was 0.007; bootstrap intervals for discrimination differences included zero. The spline association was nonsignificant ( P = 0.133), and continuous estimates were sensitive to extreme-value handling. The two summaries showed different patterns of association in the fitted models, but these findings do not establish robust incremental prognostic value for ΔbaPWV and do not support its routine use for risk stratification.