Prognostic significance of estimated pulse wave velocity in critically ill patients with coronary heart disease: analysis from the Medical Information Mart for Intensive Care IV database.

Background: There are currently no specialized risk scoring systems for critically ill patients with coronary heart disease (CHD). Arterial stiffness, as measured by estimated pulse wave velocity (ePWV), has emerged as a potential indicator of mortality or adverse cardiovascular events in individuals with CHD. This study aimed to evaluate the association between ePWV and all-cause mortality among critically ill patients with CHD beyond traditional risk scores.

Methods and results: This study included 11 001 participants with CHD from the Medical Information Mart for Intensive Care IV, with a 1-year follow-up. The primary endpoint was 1-year all-cause mortality, and the secondary endpoint was in-hospital mortality. Elevated ePWV was significantly associated with higher risks of in-hospital [odds ratio 1.15, 95% confidence interval (CI) 1.12-1.17, P < 0.001] and 1-year (hazard ratio 1.21, 95% CI 1.20-1.23, P < 0.001) mortality. These associations remained consistent when adjusted for traditional risk scores and potential confounders. When ePWV was integrated into traditional risk scoring models (Oxford Acute Severity of Illness Score, Sequential Organ Failure Assessment score, Acute Physiology Score III, Systemic Inflammatory Response Syndrome score, Simplified Acute Physiology Score II, and Logistic Organ Dysfunction System score), the predictive accuracy (area under the curve: 64.55-70.56, 64.32-72.51, 72.35-75.80, 55.58-67.68, 71.27-73.53, and 67.24-73.40, P < 0.001) and reclassification (net reclassification index: 0.230, 0.268, 0.257, 0.255, 0.221, and 0.254; integrated discrimination improvement: 0.049, 0.072, 0.054, 0.068, 0.037, and 0.061, P < 0.001) of these models significantly improved for 1-year mortality. Similar results were also found for in-hospital mortality.

Conclusions: Estimated pulse wave velocity is a strong independent predictor of both short- and long-term mortality in critically ill patients with CHD. Importantly, integrating ePWV into traditional risk scores significantly boosts the predictive accuracy for 1-year and in-hospital all-cause mortality.