Impact of Cardio-Ankle Vascular Index on Long-Term Outcome in Patients with Acute Coronary Syndrome

Abstract

The purpose of this study is to investigate the impact of arterial stiffness assessed using Cardio-ankle Vascular Index (CAVI) on long-term outcome after acute coronary syndrome (ACS). Methods: A total of 387 consecutive patients (324 males; age, 64 11 years) with ACS were enrolled. We examined CAVI and brachial-ankle pulse wave velocity (ba PWV) as the parameters of arterial stiffness. The patients were divided into two groups according to the cutoff value of CAVI determined using the receiver operating characteristic curve for the prediction of major adverse cardiovascular events (MACE): low-CAVI group, 177 patients with CAVI 8.35; high-CAVI group, 210 patients with CAVI ≥ 8.35. The primary endpoint was the incidence of MACE (cardiovascular death, recurrence of ACS, heart failure requiring hospitalization, or stroke). Results: A total of 62 patients had MACE. Kaplan-Meier analysis demonstrated a significantly higher probability of MACE in the high-CAVI group than in the low-CAVI group (median follow-up: 62 months; log-rank, p 0.001). Multivariate analysis suggested that CAVI was an independent predictor of MACE (hazard ratio [HR], 1.496; p 0.02) and cardiovascular death (HR, 2.204; p 0.025), but ba PWV was not. We investigated the incremental predictive value of adding CAVI to the GRACE score (GRS), a validated scoring system for risk assessment in ACS. Stratified by CAVI and GRS, a significantly higher rate of MACE was seen in patients with both higher CAVI and higher GRS than the other groups (p 0.001). Furthermore, the addition of CAVI to GRS enhanced net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI, 0.337, p 0.034; and IDI, 0.028, p 0.004). Conclusion: CAVI was an independent long-term predictor of MACE, especially cardiovascular death, adding incremental clinical significance for risk stratification in patients with ACS. has attracted attention as a potentially useful parameter for risk stratification of patients with ACS 3, 4). Cardio-ankle vascular stiffness index (CAVI) is a noninvasive measure of arterial stiffness that is not influenced by blood pressure at the time of examination 5, 6). We previously reported that high CAVI was an independent predictor of cardiovascular (CV) events and nonfatal ischemic stroke in patients with ACS 3). However,

New Horizons of Arterial Stiffness Developed Using Cardio-Ankle Vascular Index (CAVI)

“…Therefore, CAVI ≥ 9.0 seems to indicate increased cardiovascular risk. On the other hand, the cut-off values for CVD events were 8.325–8.35 in patients with acute coronary syndrome 13 , 16 ) . Gohbara et al 13 ) reported that CAVI > 8.325 was an independent predictor of CV events (hazard ratio 18.0).…”

“…Gohbara et al 13 ) reported that CAVI > 8.325 was an independent predictor of CV events (hazard ratio 18.0). Kirigaya et al 16 ) reported that CAVI was an independent predictor of major adverse cardiovascular events, but baPWV was not. Therefore, an optimal CAVI cut-off value of 8 may be recommended for secondary prevention of CV events.…”

“…The participants in all the studies were at high risk for CVD, such as having hypertension, diabetes, obesity, CKD, and a history of CVD. Nine studies were from Japan 8 – 16 ) , and the other two were from Taiwan 17 ) and Lithuania 18 ) . In most studies, baseline CAVI was a predictor of future CV events.…”

Basic Research Sheds Light on the Aspect of Cardio-Ankle Vascular Index (CAVI) including Elastic and Muscular Arteries

“…A recent review article published in the Journal of Atherosclerosis and Thrombosis summarized that CAVI is associated with the presence of atherosclerotic diseases including coronary artery disease, cerebral infarction, chronic kidney disease, and thickening of the carotid intima-media thickness, and coronary risk factors, such as hypertension, diabetes mellitus, uric acid disorders, sleep apnea syndrome, smoking, and obesity in several cross-sectional studies 3) . In addition, several prospective studies demonstrated that CAVI is a predictor of cardiovascular outcomes 3) including that CAVI is an independent long-term predictor of major adverse cardiovascular events, particularly cardiovascu-lar death, in patients with acute coronary syndrome 4) . Moreover, high CAVI (cut-off point of ≥ 9) was reported to be independently associated with a rapid decline in glomerular filtration rate in patients at high risk of cardiovascular disease with or without chronic kidney disease, which suggested that systemic vascular stiffness predicted a decrease in renal function in this population 5) .…”

Further Role of Blood Pressure-Independent CAVI in Addition to a Predictor of Cardiovascular Events

“…Recently, Kirigaya et al have published important paper in Journal of Atherosclerosis and Thrombosis (JAT) 1) . They reported that arterial stiffness assessed using the cardio-ankle vascular index (CAVI) was a significant predictor of major adverse cardiovascular events (MACE) and death for 62 months in patients with acute coronary syndrome (ACS) after adjustment for the established coronary risk factor.…”