Additive Value Of Pulse Pressure In Predicting Obstructive Coronary Artery Disease Beyond Traditional Risk Factors

Pulse pressure (PP) is usually increased in patients with coronary artery disease (CAD). This study was performed to investigate whether increased PP is predictive of angiographic obstructive CAD beyond traditional risk factors.Study data were obtained from a nation-wide registry, composed of 933 patients (age, 59.4 ± 10.8 years, 710 women) with suspected CAD who underwent invasive coronary angiography. Obstructive CAD was defined as angiographic findings of ≥ 50% diameter stenosis in any major epicardial coronary arteries.A total of 334 patients (35.8%) had obstructive CAD. Patients with obstructive CAD were older and male predominant, and had higher incidence of hypertension, diabetes mellitus, cigarette smoking, renal insufficiency and left ventricular diastolic dysfunction, as compared to patients without CAD. Brachial PP was significantly higher in patients with obstructive CAD than those without (54.5 ± 15.4 vs. 44.6 ± 11.9 mmHg, P < 0.001). In multivariable logistic regression analysis, old age (≥ 63 years; OR [odds ratio], 2.3; P = 0.009) diabetes mellitus (OR, 2.5; P = 0.015) cigarette smoking (OR, 2.5; P = 0.05) and higher PP (≥ 55 mmHg; OR 3.4; P < 0.001) were independent risk factors for obstructive CAD even after controlling potential confounders. The incidences of obstructive CAD in patients having 0, 1, 2, 3, and 4 of these 4 independent risk factors were 18.1%, 31.8%, 52.9%, 80.9% and 100%, respectively (P < 0.001).Higher brachial PP has an additive value in predicting obstructive CAD beyond traditional risk factors. With traditional risk factors, information on brachial PP is useful in identifying CAD patients.