Abstract 12178: Association of Inter-Arm Blood Pressure Differences (iad) With Future Cardiovascular Events (cv) in the Patients With Coronary Artery Disease (cad)
Background: Recent studies have shown that IAD could be one of the risks of CV events. However, there is no report regarding IAD in patients with CAD. Hence, we investigated whether presence of IAD relates with the severity of CAD and predicts future CV events in CAD patients.
Methods: We analyzed 657 stable patients with suspected CAD, we measured blood pressure(BP) of both hands simultaneously by using ankle brachial index (ABI) on admission, We examined the presence of CAD by coronary angiography (>75% stenosis) and calculated gensini score for evaluating the severity of coronary atherosclerosis. We defined higher IAD value is 10mmHg < differences and abnormal value of ABI is <0.9 in either leg.
Result: Mean IAD values were significantly higher in CAD patients (n=407) compared to non-CAD patients (n=250) (4.3±5.2 mmHg vs. 2.8±2.5 mmHg, P<0.01). In CAD patients, 29 patients (7.1% of CAD patients) had higher IAD, and 63(15.5%) had lower ABI. IAD values of lower ABI group were significantly higher than normal group (6.9±7.8 mmHg vs. 3.8±4.5 mmHg, P<0.01). By multivariate logistic regression analysis, BMI, female, ABI, LDL, Gensini score, were independently associated with the presence of IAD. Gensini score was significantly elevated in higher IAD group than lower IAD group(60.9±32.4 mmHg vs.41.2±28.5 mmHg, P<0.01), and after patients were divided into 4 groups according to a combination of ABI value and IAD value, gensini score was highest (80.5±33.9)in lower ABI and higher IAD group among 4 groups (p<0.01) Kaplan-Meier analysis demonstrated that higher IAD group had a significantly higher probability of CV events than lower IAD group (log rank test, P<0.01), furthermore, lower ABI and higher IAD group had a highest probability of CV events among 4 groups (log-rank test, p<0.001). Cox hazard analysis revealed that higher IAD was independent predictor of CV events [hazard ratio: 2.86, 95% confidence interval (1.51-5.40), P=0.001] in the patients with CAD.
Conclusion: IAD value was significantly higher in CAD patients and was correlated with severity of CAD. More than 10mmHg IAD independently associated with the occurrence of CV events. The measurement of BP of both hands simultaneously is useful for risk stratification of CAD patients.
- Blood pressure determination
- Peripheral vasculature
- Ankle-brachial index (ABI)
- Coronary artery disease
Author Disclosures: T. Tokitsu: None. E. Yamamoto: None. Y. Hirata: None. K. Fujisue: None. K. Sugamura: None. S. Hokimoto,: None. S. Sugiyama: None. H. Ogawa: Other Research Support; Modest; AstraZeneca, Astellas, Boehringer lngelheim, Bristol-Myers Squibb, Daiichi Sankyo, Dainippon Sumitomo Pharma, Kowa, MSD, Novartis, Pfizer, Sanofi, Takeda. Other Research Support; Significant; Bayer, Chugai, Otsuka. Honoraria; Modest; AstraZeneca, Bayer, Pfizer, Sanofi, Takeda. Honoraria; Significant; Daiichi Sankyo, MSD.
- © 2014 by American Heart Association, Inc.