What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary Artery Disease (n=321). Intervention: Brachial-ankle pulse wave velocity (baPWV) vs. Lowest baPWV tertile. Primary outcome: High SYNTAX score (>18) (OR 4.13, 95% CI 1.12-5.27, p=0.03).

January 1, 2012Open Access

Relationship between Arterial Stiffness Assessed by Brachial-Ankle Pulse Wave Velocity and Coronary Artery Disease Severity Assessed by the SYNTAX Score

Key Result

Higher arterial stiffness, as measured by brachial-ankle pulse wave velocity, was significantly associated with greater coronary artery disease severity, with the highest tertile having an OR of 4.13 for a high SYNTAX score compared to the lowest tertile.

Study Design

Type

Cross-Sectional (n=321)

Multicenter

Structured PICO

Is arterial stiffness assessed by brachial-ankle pulse wave velocity associated with coronary artery disease severity assessed by the SYNTAX score in patients with suspected CAD?

Population

321 South Chinese adults with suspected coronary artery disease who underwent both brachial-ankle pulse wave velocity measurement and coronary angiography.

Exposure

Measurement of brachial-ankle pulse wave velocity (baPWV)

Outcome

Severity of coronary artery disease assessed by angiography and the SYNTAX scoresurrogate

Arterial stiffness measured by brachial-ankle pulse wave velocity is significantly associated with the severity and complexity of coronary artery disease as assessed by the SYNTAX score.

Main Result

Odds Ratio: 4.13 (95% CI 1.12–5.27)

p-value: p=0.03

Limitations

Single-center study population may not represent the entire Chinese population
Cross-sectional design makes it impossible to assess causality between baPWV and CAD severity
Arterial stiffness was measured using baPWV rather than the gold-standard carotid-femoral PWV
Lack of HbA1c results prevented analysis of the contribution of diabetes control to arterial stiffness and SYNTAX score

Abstract

AIM: The SYNTAX score is a semi-quantitative angiographic tool used to determine the extent and severity of coronary artery disease (CAD). Automatic computer-assisted measurement of the brachial-ankle pulse wave velocity (baPWV) is a reproducible and valid method by which to assess arterial stiffness. Limited information is available for the association between the SYNTAX score and arterial stiffness in a CAD patient. We aim to assess the association between arterial stiffness determined by PWV and CAD severity assessed by angiography and the SYNTAX score. METHODS: 321 subjects underwent measurement of both baPWV and angiography from 2010 to 2011. BaPWV was divided into tertiles. Multiple logistic and linear regression analyses were used to evaluate the relationship between the SYNTAX score and baPWV. RESULTS: After adjusting for age, body mass index, smoking habits, family history of CAD, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), total cholesterol, triglycerides, LDL-cholesterol, fasting glucose, serum creatinine, uric acid and cysteine proteinase, analyses revealed that baPWV groups were significantly associated with the SYNTAX score. Compared with the lowest baPWV tertile, the adjusted odds ratios (ORs) of having a SYNTAXHIG for the MID and HIG baPWV tertiles were 4.76 (95% confidence interval: 1.71-6.33) and 4.13 (95% confidence interval: 1.12-5.27), respectively. We also used multiple linear regression analyses to assess the association between baPWV and the SYNTAX score, which showed that baPWV was associated with the SYNTAX score. CONCLUSION: Arterial stiffness determined by PWV is related to CAD severity assessed by angiography and the SYNTAX score.

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