P24 SEX-SPECIFIC PULSE WAVE VELOCITY CUT-OFFS IMPROVE SURVIVAL ANALYSIS IN PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE

Abstract

Objectives: There is evidence for sex and age influences on pulse wave velocity (PWV). Guidelines suggest a sex-independent cut-off for PWV. It is not obvious that an age- and blood-pressure-independent cut-off is suitable in different populations [1, 2]. Thus, the aim is to investigate the suitability of sex-independent cut-offs for risk prediction in a high-risk cohort. Methods: PWV was measured invasively (invPWV; catheter pullback) and non-invasively (non- invPWV; ARCSolver PWV) for patients with suspected CAD at the hospital in Wels- Grieskirchen (Austria). Patients were grouped in four subgroups based on sex and PWV cut-offs (guidelines and sex-specific ones). A combination of myocardial infarction, death, stroke and cardiovascular revascularization served as primary endpoint. Kaplan-Meier curves, logrank test and hazard-ratios were used for survival analysis and receiver-operating-characteristics (ROC) to determine sex-specific cut- offs. Results: 604 male (61 (11 SD) years) and 324 female (65 (11 SD) years) with a median follow-up of 1576 days and 215 events were included. Logrank test revealed significant differences between Kaplan-Meier curves (p < 0.001), but dichotomized PWV remained just discriminative in women, but not men, for invasive and non- invasive recordings. ROC analysis revealed sex-specific cut-offs of 8.5 m/s (men) or 9.6 m/s (women) for invasive and 8.9 m/s (men) or 10.0 m/s (women) for non- invasive recordings. When using these cut-offs, PWV turned out to be discriminative in both sexes (Table). HR (≤10m/s vs. >10m/s) Sex-specific cut-off HR (≤ sex-specific cut-off vs. > sex-specific cut-off) invPWV Male 1.41 [0.94; 2.11] 8.5 m/s 1.64 [1.15; 2.34] Female 2.46 [1.58; 3.84] 9.6 m/s 3.28 [2.14; 5.03] non-invPWV Male 1.46 [0.99; 2.16] 8.9 m/s 1.73 [1.22; 2.46] Female 3.20 [2.11; 4.85] 10.0 m/s 3.20 [2.11; 4.85] Table.Results of survival and ROC analysis for invasive and non-invasive PWV for male and female. Hazard-ratios (HR) are presented with their 95% confidence intervals. Conclusion: Sex-specific PWV cut-offs improve survival analysis in patients with suspected CAD. Cut-offs seem to be directly dependent on the prevalence of CAD and thus need further investigation.