Arterial excess‑reservoir pressure integral as a predictor of cardiovascular complications in patients with acute coronary syndrome.

INTRODUCTION    The excess pressure-time integral (excess PTI) and reservoir pressure-time integral(reservoir PTI) are new measures derived from blood pressure (BP) waveform decomposition. Thesemarkers predict cardiovascular (CV) complications and are associated with target organ  damage inpa tients on antihypertensive treatment or those with chronic and acute heart failure. OBJECTIVES    We investigated whether reservoir PTI or excess PTI predict future CV events (death, stroke, myocardial infarction [MI]) in patients with acute coronary syndrome (ACS) and reduced ejection fraction (EF). PATIENTS AND METHODS    BP waveforms were obtained by radial tonometry in 251 patients with ACS (median age, 64 years) and reduced EF (median, 40%). Left ventricular EF was assessed by transthoracic echocardiography. Reservoir PTI and excess PTI were derived by decomposition of the BP waveform RESULTS    A total of 78 CV events occurred during the follow‑up (median, 1245 days). A Kaplan-Meier analysis showed that the highest tertile of excess PTI was a significant predictor of adverse outcome. A multivariate Cox regression analysis demonstrated that excess PTI was a predictor of CV events after adjustment for EF, age, history of stroke, MI, and coronary artery bypass grafting (hazard ratio, 1.9; 95% confidence interval, 1.1-3.3; P = 0.02). CONCLUSIONS    In conclusion, excess PTI, a new measure derived from reservoir-pressure analysis, predicts outcome in survivors of ACS with reduced EF.