Incremental prognostic value of combined information of arterial stiffness and the result of treadmill exercise test in patients with suspected coronary artery disease

The effectiveness of diagnostic tools can be enhanced by their combination. This study aimed to investigate whether arterial stiffness data, obtained by brachial-ankle pulse wave velocity (baPWV) measurement, could improve prognostic value to exercise treadmill test (ETT) to predict future cardiovascular events. A total of 1,788 consecutive subjects (mean age 55.8 ± 10.7 years, 59.1% men) with suspected of having coronary artery disease (CAD), who underwent ETT and baPWV on the same day were prospectively recruited. The study outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and coronary revascularization. During a mean follow-up period of 875 days (interquartile range, 116–2,212 days), there were 88 cases of MACE (4.9%). The elevated baPWV (≥ 1,440 cm/s) (hazard ratio [HR] 5.18, 95% confidence interval [CI] 2.68–10.0, P  < 0.001) and positive ETT result (HR 2.81, 95% CI 1.77–4.47, P  < 0.001) were associated with MACE even after adjustment for potential confounders. The combination of baPWV to traditional risk factors and ETT result further stratified the subjects’ risk (low baPWV and negative ETT result vs high baPVW and positive ETT result; HR 16.44, 95% CI 6.17–43.78, P  < 0.001). Arterial stiffness, assessed by baPWV, had incremental prognostic value to ETT result in patients with suspected of CAD. Combined information of baPWV and ETT result can serve as a useful clinical tool for risk stratification in this high-risk patient population.