Prognostic significance of the novel START arterial stiffness index in patients with coronary artery disease after coronary artery bypass grafting

Aim. To study the long-term prognostic value of the novel START vascular stiffness index in patients with coronary artery disease (CAD) after coronary artery bypass grafting (CABG).

Material and methods. The study included 256 patients with CAD who underwent CABG at the Kemerovo Research Institute for Complex Issues of Cardiovascular Diseases. Before surgery, vascular stiffness was assessed using the haSTART cardio-ankle index. The mean follow-up period was 9,7±0,9 years. Two following study groups were formed: Group I — haSTART < the median (Me) index of 8,4 (haSTART <Me (n=118)); group II — haSTART ≥ the median (haSTART ≥Me, n=138). The prognostic value of haSTART was studied in relation to the following composite end point (CEP): death, non-fatal myocardial infarction, or stroke.

Results. Patients in the haSTART ≥Me group were significantly older than in the haSTART <Me group (p<0,001). In both groups, men predominated (76,2%). During the follow-up period, all-cause death was significantly more common in the haSTART ≥Me group (34,1%) than in the haSTART <Me group (19,5%), p=0,009. Cardiovascular death was also more common in the haSTART ≥Me group than in the haSTART <Me group (23,2% vs 8,5%, p=0,001). In patients with haSTART ≥Ме, CEP was observed in 45,7% of cases, compared to patients with haSTART <Ме (30,5%), p=0,013. Among patients with fatal outcome, the prevalence of patients with haSTART ≥Ме values was higher than in the group of survivors (67,1% and 48,9%, p=0,009). Among patients with CEP — the detection rate of haSTART ≥Ме was 63,6%, which was significantly higher than in the group of survivors without cardiovascular events (47,8%, p=0,013). Kaplan-Meier curves revealed a better long-term prognosis in the haSTART <Me group to the haSTART ≥Me group (p>0,05).

Conclusion. Evaluation of the haSTART stiffness index before CABG surgery may have prognostic value in the long-term follow-up period in patients with CAD.

1. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-646. doi:10.1161/CIR.0000000000000678.

2. Sang T, Lv N, Dang A, et al. Brachial-ankle pulse wave velocity and prognosis in patients with atherosclerotic cardiovascular disease: a systematic review and meta-analysis. Hypertens Res. 2021;44(9):1175-85. doi:10.1038/s41440-021-00678-2.

3. Vasyuk YuA, Ivanova SV, Shkolnik EL, et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Cardiovascular Therapy and Prevention. 2016;15(2):4-19. (In Russ.) doi:10.15829/1728-8800-2016-2-4-19.

4. Shirai K, Utino J, Otsuka K, et al. Novel Blood Pressure-independent Arterial Wall Stiffness Parameter; Cardio-Ankle Vascular Index (CAVI). Journal of Atherosclerosis and Thrombosis. 2006;13(2):101-7. doi:10.5551/jat.13.101.

5. Namba T, Masaki N, Takase B, Adachi T. Arterial Stiffness Assessed by Cardio-Ankle Vascular Index. International Journal of Molecular Sciences. 2019;20(15):3664. doi:10.3390/ijms20153664.

6. Matsushita K, Ding N, Kim ED, et al. Cardio-ankle vascular index and cardiovascular disease: Systematic review and meta-analysis of prospective and cross-sectional studies. J. Clin. Hypertens. 2019;21:16-24. doi:10.1111/jch.13425.

7. Zairova AR, Rogoza AN, Oshchepkova EV, et al. Contribution of cardio-ankle vascular index to prediction of cardiovascular events in the adult urban population: data from the ESSE-RF study (Tomsk). Cardiovascular Therapy and Prevention. 2021;20(5):2967. (In Russ.) doi:10.15829/1728-8800-2021-2967.

8. Sumin AN, Shcheglova AV, ZHidkova II, et al. Assessment of Arterial Stiffness by Cardio-Ankle Vascular Index for Prediction of Five-Year Cardiovascular Events After Coronary Artery Bypass Surgery. Global Heart. 2021;16(1):90. doi:10.5334/gh.1053.

9. Shirai K, Suzuki K, Tsuda S, et al. Comparison of Cardio-Ankle Vascular Index (CAVI) and CAVI0 in Large Healthy and Hypertensive Populations. J Atheroscler Thromb. 2019; 26(7):603-15. doi:10.5551/jat.48314.

10. Bakholdin IB, Milyagin VA, Talov AV, et al. The STELARI START index a new promising indicator of vascular stiffness. Vestnik of the SSMA. 2022;21(3):95-192. (In Russ.) doi:10.37903/vsgma.2022.3.11.

11. Sumin АN, Shcheglova AV, Bakholdin IB. The possibilities of the new START indicator in the assessment of vascular stiffness in healthy individuals. "Arterial'naya Gipertenziya" ("Arterial Hypertension"). 2023;29(1):38-50. (In Russ.) doi:10.18705/1607-419X-2023-29-1-38-50.

12. Vasyutin IA, Leon K, Safronova TA, et al. Comparison of the novel START vascular stiffness index with the CAVI index, assessment of their values and correlations with clinical parameters. Russian Journal of Cardiology. 2023;28(1):5272. (In Russ.) doi:10.15829/1560-4071-2023-5272.

13. Sumin AN, Shcheglova AV, Bakholdin IB. Comparative analysis of START and CAVI arterial stiffness scores in hypertensive patients. Cardiovascular Therapy and Prevention. 2023;22(3):3473. (In Russ.) doi:10.15829/1728-8800-2023-3473.

14. Sumin AN, Shcheglova AV, Gorelova IV, et al. Potential of the novel START index in assessing arterial stiffness in patients with coronary artery disease. Russian Open Medical Journal. 2023;12:e0410. doi:10.15275/rusomj.2023.0410.

15. Spronck B, Avolio AP, Tan I, et al. Arterial stiffness index beta and cardio-ankle vascular index inherently depend on blood pressure but can be readily corrected. J Hypertens. 2017;35(1):98-104. doi:10.1097/HJH.0000000000001132.