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Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction
BACKGROUND: High aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST‐elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far. METHODS AND RESU...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634252/ https://www.ncbi.nlm.nih.gov/pubmed/28887316 http://dx.doi.org/10.1161/JAHA.117.005590 |
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author | Feistritzer, Hans‐Josef Klug, Gert Reinstadler, Sebastian J. Reindl, Martin Niess, Lea Nalbach, Timo Kremser, Christian Mayr, Agnes Metzler, Bernhard |
author_facet | Feistritzer, Hans‐Josef Klug, Gert Reinstadler, Sebastian J. Reindl, Martin Niess, Lea Nalbach, Timo Kremser, Christian Mayr, Agnes Metzler, Bernhard |
author_sort | Feistritzer, Hans‐Josef |
collection | PubMed |
description | BACKGROUND: High aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST‐elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far. METHODS AND RESULTS: This prospective observational study included 160 consecutive patients with first acute ST‐elevation myocardial infarction. Aortic pulse wave velocity (PWV) was measured 2 (interquartile range 2‐4 days) days after infarction using cardiac magnetic resonance imaging. The primary end point was defined as a composite end point of major adverse cardiac and cerebrovascular events (MACCE) comprising death, nonfatal myocardial reinfarction, new congestive heart failure, and stroke. During a median follow‐up of 1.2 years (interquartile range 1.0‐3.1 years), 19 (12%) MACCE events occurred. Kaplan‐Meier analysis showed a significantly lower MACCE‐free survival in patients with high PWV (PWV >7.3 m/s, log‐rank P=0.003). Multivariable Cox regression analysis revealed PWV >7.3 m/s to be an independent predictor of MACCE after adjustment for age, sex, mean blood pressure, N‐terminal pro–brain natriuretic peptide levels, presence of multivessel disease, and left ventricular stroke volume (hazard ratios ≥3.5; 95% confidence interval 1.4‐13.3; all P≤0.018). In reclassification analysis the addition of PWV to a risk model comprising major clinical prognostic parameters led to a net reclassification improvement of 0.11 (95% confidence interval 0.06‐0.17; P<0.001). CONCLUSIONS: Increased aortic stiffness is an independent predictor of MACCE after acute ST‐elevation myocardial infarction. Moreover, the assessment of aortic stiffness in addition to classical risk factors significantly improved early risk stratification. |
format | Online Article Text |
id | pubmed-5634252 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-56342522017-10-18 Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction Feistritzer, Hans‐Josef Klug, Gert Reinstadler, Sebastian J. Reindl, Martin Niess, Lea Nalbach, Timo Kremser, Christian Mayr, Agnes Metzler, Bernhard J Am Heart Assoc Original Research BACKGROUND: High aortic stiffness has been shown to be a strong predictor of morbidity and mortality in the general population and several patient cohorts. However, in patients after ST‐elevation myocardial infarction, the prognostic value of high aortic stiffness is unknown so far. METHODS AND RESULTS: This prospective observational study included 160 consecutive patients with first acute ST‐elevation myocardial infarction. Aortic pulse wave velocity (PWV) was measured 2 (interquartile range 2‐4 days) days after infarction using cardiac magnetic resonance imaging. The primary end point was defined as a composite end point of major adverse cardiac and cerebrovascular events (MACCE) comprising death, nonfatal myocardial reinfarction, new congestive heart failure, and stroke. During a median follow‐up of 1.2 years (interquartile range 1.0‐3.1 years), 19 (12%) MACCE events occurred. Kaplan‐Meier analysis showed a significantly lower MACCE‐free survival in patients with high PWV (PWV >7.3 m/s, log‐rank P=0.003). Multivariable Cox regression analysis revealed PWV >7.3 m/s to be an independent predictor of MACCE after adjustment for age, sex, mean blood pressure, N‐terminal pro–brain natriuretic peptide levels, presence of multivessel disease, and left ventricular stroke volume (hazard ratios ≥3.5; 95% confidence interval 1.4‐13.3; all P≤0.018). In reclassification analysis the addition of PWV to a risk model comprising major clinical prognostic parameters led to a net reclassification improvement of 0.11 (95% confidence interval 0.06‐0.17; P<0.001). CONCLUSIONS: Increased aortic stiffness is an independent predictor of MACCE after acute ST‐elevation myocardial infarction. Moreover, the assessment of aortic stiffness in addition to classical risk factors significantly improved early risk stratification. John Wiley and Sons Inc. 2017-09-08 /pmc/articles/PMC5634252/ /pubmed/28887316 http://dx.doi.org/10.1161/JAHA.117.005590 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial (http://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Feistritzer, Hans‐Josef Klug, Gert Reinstadler, Sebastian J. Reindl, Martin Niess, Lea Nalbach, Timo Kremser, Christian Mayr, Agnes Metzler, Bernhard Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
title | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
title_full | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
title_fullStr | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
title_full_unstemmed | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
title_short | Prognostic Value of Aortic Stiffness in Patients After ST‐Elevation Myocardial Infarction |
title_sort | prognostic value of aortic stiffness in patients after st‐elevation myocardial infarction |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634252/ https://www.ncbi.nlm.nih.gov/pubmed/28887316 http://dx.doi.org/10.1161/JAHA.117.005590 |
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