Association between major adverse cardiovascular events and brachial-ankle pulse wave velocity and a difference in blood pressure between arms after percutaneous coronary intervention

Arterial stiffness is well known to be an important risk factor for cardiovascular events. Although brachial-ankle pulse wave velocity (baPWV) and bilateral blood pressure (BP) in the arms are measured routinely, it is uncertain whether baPWV and the difference in BP between the arms could predict major adverse cardiovascular events (MACE) after elective percutaneous coronary intervention (PCI). We retrospectively examined 398 stable angina patients who underwent successful bare metal stent (BMS) or drugeluting stent (DES) implantation and in whom we could measure lt. and rt. baPWV and BP in both arms. We also calculated the absolute (|rt. BP-lt. BP|) and relative (rt. BP-lt. BP) differences in systolic BP (SBP) and diastolic BP between the arms. During the follow-up period (9±3 months), 13 % of the total patients had MACE [all-cause death, myocardial infarction, target lesion revascularization (PCI or coronary artery bypass grafting)]. In a multivariate analysis, stent size, left ventricular ejection fraction, type of stent and insulin use were significantly associated with MACE in all patients. In the BMS group, stent size was significantly associated with MACE. Interestingly, in patients with DES implantation, the relative difference in SBP between arms, lt. baPWV and insulin use were independent predictors of MACE. The cut-off levels of lt. baPWV and relative SBP between the arms for predicting MACE were 1854 cm/sec and 0 mmHg, respectively. In conclusion, both the relative difference in SBP between the arms and baPWV in addition to insulin use predicted MACE after DES implantation, but not BMS implantation.