title: Inflection point of ascending aortic waveform is a predictive factor for major adverse cardiac events after successful coronary stent placement in acute myocardial infarction.
abstract: OBJECTIVE
  The reflection waveform in the ascending aortic pressure has been reported to reflect systemic arterial stiffness, and increase the risk of coronary heart disease. The purpose of this study is to evaluate prospectively whether the reflection waveform in the ascending aortic pressure is associated with the risk of major adverse cardiac events (MACE) after successful coronary stenting in acute myocardial infarction (AMI).
  
  
  RESULTS
  One hundred and twenty-five patients with AMI and undergoing successful coronary stenting were enrolled in this study. We measured the inflection time to determine the reflection waveform in the ascending aortic pressure at angioplasty. Inflection time was defined as the time interval from initiation of a systolic pressure waveform to the inflection point. During a period of 2945 person-months, we confirmed 42 cases of MACE. Shorter inflection time increased incident MACE. Kaplan-Meier analysis demonstrated a significantly reduced event-free rate in patients with inflection time < or = 86 ms (MACE; p < 0.01, cardiovascular death; p < 0.001 by log-rank test). The multiple-adjusted hazard ratio for a I standard deviation (SD) magnitude decrease in inflection time was 1.46 (95% confidence interval, 1.03 to 2.05) for MACE, and 5.76 (95% confidence interval, 1.78 to 18.67) for cardiovascular death.
  
  
  CONCLUSIONS
  Shorter inflection time increased the risk of MACE after successful coronary stenting in patients with AMI.
authors.affiliation: Department of Cardiology, Ishikiriseiki Hospital, 18-28, Yayoi, Higashiosaka, Osaka, 579-8026, Japan. hiroyasu-sayaka@joy.ocn.ne.jp
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ueda
authors.forename: Tomoshige
authors.initials: T
authors.lastname: Hayashi
authors.forename: Kei
authors.initials: K
authors.lastname: Tsumura
authors.forename: Kiyomichi
authors.initials: K
authors.lastname: Yoshimaru
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshikawa
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001011:Aorta / Q000502:physiology*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D003643:Death; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents