Anila Veerani

Aortic Pressure Augmentation Predicts Adverse Cardiovascular Events in Patients With Established Coronary Artery Disease

Pulse pressure (PP), a marker of arterial stiffness, predicts cardiovascular risk. We aimed to determine whether augmentation pressure (AP) derived from the aortic pressure waveform predicts major adverse cardiovascular events (MACE) and death independently of PP in patients with established coronary artery disease (CAD). We prospectively followed-up 297 males undergoing coronary angiography for 1186±424 days. Ascending aortic pressure tracings obtained during catheterization were used to calculate AP (difference between the second and the first systolic peak). Augmentation index (AIx) was defined as AP as a percentage of PP. We evaluated whether AP and AIx can predict the risk of MACE (unstable angina, acute myocardial infarction, coronary revascularization, stroke, or death) and death using Cox regression. All models evaluating AP included PP to assess whether AP adds to the information already provided by PP. Both AP and AIx significantly predicted MACE. The hazard ratio (HR) per 10 mm Hg increase in AP was 1.20 (95% confidence interval [CI], 1.08 to 1.34; P<0.001); the HR for each 10% increase in AIx was 1.28 (95% CI, 1.11 to 1.48; P=0.004). After adjusting for other univariate predictors of MACE, age, and other potential confounders, AP remained a significant predictor of MACE (HR per 10 mm Hg increase=1.19; 95% CI, 1.06 to 1.34; P=0.002), as did AIx (adjusted HR, 1.28; 95% CI, 1.09 to 1.50; P=0.003). AP was a significant predictor of death (HR per 10 mm Hg increase=1.18; 95% CI, 1.02 to 1.39; P=0.03). Higher AIx was associated with a trend toward increased mortality (HR=1.22; 95% CI, 0.98 to 1.52; P=0.056). Aortic AP predicts adverse outcomes in patients with CAD independently of PP and other risk markers.

Body Mass Index Is Not a Risk Factor for Unstable Angina and Myocardial Infarction in Veteran Patients With Angiographically Confirmed Coronary Artery Disease

To the Editor: We read with great interest the article by Wolk et al,1 which reported a correlation between body mass index (BMI) and unstable coronary artery disease (CAD) in a cross-sectional analysis of 382 patients undergoing cardiac catheterization. To test this correlation in a different population, we examined our database of prospectively collected data from a study examining the association between C-reactive protein (CRP) and the risk of cardiovascular events. Our population consisted of 368 consecutive patients undergoing coronary angiography at the Miami VA Medical Center. Patients with coronary artery stenosis of >10% were included in further analyses (n=336; BMI 28.6±5.0 m/kg2; age 63.1±10.4 years). In cross sectional analysis, the BMI was not predictive of unstable CAD (odds ratio [OR] per SD increase in BMI: 0.93; 95% confidence interval [CI]: 0.74 to 1.17; P =0.57). Furthermore, we analyzed the relationship between BMI and the risk of reaching the combined endpoint (CE) of acute myocardial infarction, unstable angina, or death during 3-year follow-up using the Cox regression method. BMI was not correlated with the risk of the CE (hazard ratio [HR] per SD increase in BMI: 1.05; 95% CI: 0.82 to 1.34; P =0.65). Correction for age and conditions associated with an increased BMI (hypertension [HTN], diabetes mellitus …