Ascending aortic, but not brachial blood pressure-derived indices are related to coronary atherosclerosis

A recent study has demonstrated that pulse pressure (PP) measured in the ascending aorta is related to the extent of coronary artery disease in patients undergoing coronary angioplasty. However, no study so far has analyzed the relation between pulsatility of the ascending aorta and the extent of coronary artery disease in consecutive patients undergoing coronary angiography. Therefore, we investigated the relation between ascending aorta pulsatility and the extent of coronary atherosclerosis in unselected patients with angiographically confirmed coronary artery disease. The study group consisted of 423 consecutive patients (334 men and 89 women; mean age: 58.6 +/- 9.7 years) with angiographically confirmed coronary artery disease and ejection fraction less than or equal to 60% PP, fractional pulse pressure (the ratio of pulse pressure to mean pressure, FPP), and the ratio of pulse pressure to diastolic pressure (pulsatility index, PI) derived from intraaortic measurements differentiated patients with one-, two- and three-vessel coronary artery disease (PP, 63.0 +/- 16.0 versus 64.2 +/- 18.3 versus 71.8 +/- 19.1 mmHg (P < 0.0001); FPP, 0.68 +/- 0.14 versus 0.69 +/- 0.15 versus 0.76 +/- 0.17 (P < 0.0001); PI 0.89 +/- 0.25 versus 0.92 +/- 0.27 versus 1.04 +/- 0.32 (P < 0.0001)). After multivariate stepwise adjustment, the odds ratio (OR) and confidence interval (CI) of having three-vessel disease was: PP per 10 mmHg OR 1.15 (95% CI 1.02-1.31); FPP per 0.1 OR 1.18 (95% CI 1.02-1.37); and PI per 0.1 OR 1.11 (95% CI 1.03-1.21). None of brachial blood pressure indices was independently related to the extent of coronary atherosclerosis. Conclusion: Pulse pressure, fractional pulse pressure, and pulsatility index of the ascending aorta are related to the risk of three-vessel disease in patients with coronary artery disease and preserved left ventricular function. (C) 2004 Elsevier Ireland Ltd. All rights reserved.