Non-invasive vascular measures as prognostic predictors for older patients with non-ST elevation acute coronary syndrome.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Coronary artery disease Pub Date : 2024-08-01 Epub Date: 2024-03-04 DOI:10.1097/MCA.0000000000001352

Valerie J Dirjayanto, Graziella Pompei, Francesca Rubino, Simone Biscaglia, Gianluca Campo, A S Mihailidou, Hester den Ruijter, Vijay Kunadian

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引用次数: 0

Abstract

Background: Adverse cardiac events are common in older patients with non-ST elevation acute coronary syndrome (NSTEACS), yet prognostic predictors are still lacking. This study investigated the long-term prognostic significance of non-invasive measures including endothelial function, carotid intima-media thickness (CIMT), and vascular stiffness in older NSTEACS patients referred for invasive treatment.

Methods: NSTEACS patients aged 75 years and older recruited to a multicentre cohort study (NCT01933581) were assessed for baseline endothelial function using endoPAT logarithm of reactive hyperemia index (LnRHI), CIMT using B-mode ultrasound, and vascular stiffness using carotid-femoral pulse wave velocity (cfPWV). Long-term outcomes included major adverse cardiovascular events (MACE), a composite of death, reinfarction, urgent revascularization, stroke/transient ischemic attack, and significant bleeding.

Results: Recruitment resulted in 214 patients assessed for LnRHI, 190 patients assessed for CIMT and 245 patients assessed for cfPWV. For LnRHI group (median follow-up 4.73 years [IQR: 1.41-5.00]), Cox regression analysis revealed a trend towards increased risk of MACE (HR: 1.24 [95% CI: 0.80-1.93]; P = 0.328) and mortality (HR: 1.49 [95% CI: 0.86-2.59]; P = 0.157), but no significance was reached. No difference for other components of MACE was found. For CIMT group (median follow up 4.74 years [IQR: 1.55-5.00]), no statistically significant difference in MACE was found (HR: 0.92 [95% CI: 0.53-1.59]; P = 0.754). Similarly, for cfPWV group (median follow-up 4.96 years [IQR: 1.55-5.00]), results did not support prognostic significance (for MACE, HR: 0.95 [95% CI: 0.65-1.39]; P = 0.794).

Conclusion: Endothelial function, CIMT and vascular stiffness were proven unsuitable as strong prognostic predictors in older patients with NSTEACS.

Clinical trial registration: NCT01933581.

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作为非 ST 段抬高急性冠状动脉综合征老年患者预后预测指标的无创血管测量方法。

背景：非 STE 抬高型急性冠状动脉综合征（NSTEACS）老年患者常见不良心脏事件，但仍缺乏预后预测指标。本研究调查了非侵入性指标（包括内皮功能、颈动脉内膜中层厚度（CIMT）和血管僵硬度）对转诊接受侵入性治疗的老年 NSTEACS 患者的长期预后意义：一项多中心队列研究（NCT01933581）招募了 75 岁及以上的 NSTEACS 患者，使用内皮细胞反应性充血指数对数（LnRHI）评估基线内皮功能，使用 B 型超声波评估颈动脉内膜中层厚度（CIMT），使用颈动脉-股动脉脉搏波速度（cfPWV）评估血管僵硬度。长期结果包括主要不良心血管事件（MACE），即死亡、再梗死、紧急血管重建、中风/短暂性脑缺血发作和严重出血的综合结果：招募结果显示，214 名患者接受了 LnRHI 评估，190 名患者接受了 CIMT 评估，245 名患者接受了 cfPWV 评估。对于 LnRHI 组（中位随访 4.73 年 [IQR：1.41-5.00]），Cox 回归分析显示 MACE（HR：1.24 [95% CI：0.80-1.93]；P = 0.328）和死亡率（HR：1.49 [95% CI：0.86-2.59]；P = 0.157）风险有增加趋势，但未达到显著性。在 MACE 的其他方面没有发现差异。CIMT组（中位随访时间为4.74年[IQR：1.55-5.00]）的MACE差异无统计学意义（HR：0.92 [95% CI：0.53-1.59]；P = 0.754）。同样，对于 cfPWV 组（中位随访 4.96 年 [IQR：1.55-5.00]），结果也不支持预后意义（MACE，HR：0.95 [95% CI：0.65-1.39]；P = 0.794）：结论：内皮功能、CIMT和血管僵硬度不适合作为NSTEACS老年患者的有力预后预测指标：临床试验注册：NCT01933581。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.