Arterial stiffness index and blood pressure phenotypes in patients undergoing percutaneous coronary intervention: prognostic implications for ischemic and bleeding events

Abstract

Background: The clinical implications of arterial stiffness in relation to hypertension remain unclear in patients undergoing percutaneous coronary intervention (PCI). This study aimed to determine whether the arterial stiffness index provides additional prognostic information regarding hypertension-related risks in this population. Methods: Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV) in 3,930 PCI patients before discharge. The primary outcome was net adverse clinical events (NACE), a composite of major adverse cardiac and cerebrovascular events (MACCE: all-cause death, myocardial infarction, stroke) and major bleeding over 4 years. The patients were categorized into four groups based on hypertensive status and baPWV phenotype (< 1,891 vs. >= 1,891 cm/s). Results: Compared to hypertensive status, the baPWV phenotype showed a stronger association with clinical outcomes. Hypertensive status and baPWV phenotype showed an additive effect on risk stratification. The highest incidence rates of clinical events were observed in the hypertensives with high baPWV, followed by the normotensives with high baPWV, hypertensives with low baPWV, and normotensives with low baPWV groups. Specifically, the 4-year incidence of NACE was 14.8%, 12.4%, 7.1%, and 6.0%, respectively, and the corresponding incidences of MACCE were 12.7%, 9.5%, 6.2%, and 5.2%, respectively. The hypertensives with high baPWV group exhibited significantly higher risks for NACE (adjusted hazard ratio [aHR], 1.556; 95% confidence interval [CI], 1.132-2.138; P = 0.006), MACCE (aHR, 1.573; 95% CI, 1.113-2.223; P = 0.010), and major bleeding (aHR, 2.023; 95% CI, 1.029-3.978; P = 0.041) compared with the normotensive with low baPWV group. Findings were consistent across subgroups for NACE without significant interactions. Conclusions: Arterial stiffness exhibited additive prognostic implications in patients undergoing PCI. The combined use of the baPWV and hypertension phenotype may enhance post-PCI risk stratification for clinical events. Trial Registration: ClinicalTrials.gov Identifier: NCT04650529