P-269: Correlation between ascending aortic pressures and outcomes in patients with coronary artery disease

Background: There is limited data about the correlation between various blood pressure levels and outcomes in patients with established coronary artery disease (CAD). Methods: We prospectively followed 324 males undergoing coronary angiography for 1161±418 days. Ascending aortic pressures were obtained during catheterization. We analyzed central systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). The study endpoints were: (1) A combined endpoint of major adverse cardiovascular events (MACE), including unstable angina, myocardial infarction, coronary revascularization, stroke or death, or; (2) All-cause mortality. Cox regression was used to assess the association of aortic pressures with the risk of reaching the study endpoints. Results: The PP significantly predicted MACE (HR per 10 mmHg increase=1.09; 95%CI=1.002-1.17; p=0.04). The DBP was inversely correlated with the risk of MACE (HR per 10 mmHg increase=0.85; 95%CI=0.74-0.98; p=0.02). These correlations remained significant after adjusting for other predictors (including diabetes mellitus, current smoking, congestive heart failure, the left ventricular ejection fraction, C-reactive protein, and the Charlson comorbidity score) and other potential confounders (including serum creatinine and the number of vessels involved with hemodynamically significant CAD). The peripheral DBP (but not the PP) inversely correlated with the risk of MACE (HR=0.87 per 10 mmHg increase; 95%CI=0.75-0.998; p=0.047). The aortic PP significantly predicted death (HR per 10 mmHg increase=1.18; 95%CI=1.05-1.33; p=0.004). In addition, the aortic DBP inversely correlated with the risk of death (HR: 0.76; 95%CI=0.62-0.94; p=0.01). These correlations were independent of other predictors. When adjusted for each other, the aortic DBP and aortic PP were independent predictors of mortality. The peripheral PP did not correlate with the risk of death. Conclusions: In patients with angiographically demonstrated CAD, aortic PP correlated positively, whereas aortic DBP correlated negatively with the risk of MACE and death; this correlation was independent of other risk markers and the angiographic severity of CAD.