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Minerva Medica 2022 Mar 10

DOI: 10.23736/S0026-4806.22.07909-5


language: English

Arterial stiffness in acute coronary syndrome as a potential triage tool: a prospective observational study

Sebastian SCHNAUBELT 1 , Julia OPPENAUER 1, Mathias BADER 1, Na DU 1, Felix EIBENSTEINER 1, Calvin L. KIENBACHER 1, Enrico BALDI 2, 3, Markus MUELLER 4, Thomas PERKMANN 5, Helmuth HASLACHER 5, Wolfgang SCHREIBER 1, Alexander NIESSNER 6, Oliver SCHLAGER 4, Hans DOMANOVITS 1, Patrick SULZGRUBER 6

1 Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; 2 Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; 3 Cardiac Intensive Care Unit, Arrhythmia, Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 4 Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria; 5 Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria; 6 Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria

BACKGROUND: Diagnosis and percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) are time-sensitive. Triage and algorithms identify patients at high-risk. However, additional prediction tools are warranted for prioritized care based on predicted coronary pathologies and PCI complexity. Pulse-wave velocity (PWV) is a non-invasive measurement related to cardiovascular morbidity, and their exact value in ACS evaluation is unclear.
METHODS: In patients undergoing coronary angiography (CA) and - if warranted - PCI for ACS evaluation at a tertiary university hospital in Vienna, Austria, brachial-ankle (ba)PWV and carotidfemoral (cf)PWV were prospectively measured from 01/2020-01/2021.
RESULTS: PWV was measured in 58 patients (60.3% male; 65 [61-69] years). Risk prediction scores (GRACE, CRUSADE, TIMI), cardiac enzymes, and fraction of patients with a three-vessel disease were significantly higher in the pathological PWV ranges. Adjusted for age and co-morbidities, baPWV independently predicted the LAD being relevantly stenotic (crude OR=1.416 [1.143-1.755], p=0.001; adjusted OR=1.340 [1.039-1.727;], p=0.024; cut-off 15.5 m/s in CART-analysis), being the culprit lesion (crude OR=1.320 [1.094-1.594], p=0.004; adjusted OR=1.311 [1.037-1.657], p=0.024; cut-off 15.5 m/s), and being totally occluded (crude OR=1.422 [1.113-1.818], p=0.005; adjusted OR=1.677 [1.189-2.366], p=0.003; cut-off 19.6 m/s). Moreover, CA or PCI complexity were associated with higher PWV.
CONCLUSIONS: Pathological PWV as a surrogate for arterial stiffness, polyvascular disease and a larger atherosclerotic burden was associated with GRACE, CRUSADE, and TIMI scores, and PCI duration and complexity. BaPWV independently predicted relevant LAD pathologies, and is suggested as a potential novel triage and prioritization tool for suspected NSTE-ACS in emergency departments.

KEY WORDS: Arterial stiffness; Pulse-wave velocity; Triage; Emergency department; Acute coronary syndrome

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