Predictive Value of Cardiopulmonary Exercise Testing Parameters in Patients under Percutaneous Coronary Intervention with High Pulse Pressure.

Abstract

Background: The correlation between cardiopulmonary exercise testing (CPET) parameters and the prognosis of patients undergoing percutaneous coronary intervention (PCI) with high pulse pressure (PP) is unclear. The purpose of present study is to investigate the correlation of CPET parameters in patients under PCI with high PP and assess their reference value for prognosis.

Methods: Individuals aged 18 years and older who were diagnosed with coronary artery disease (CAD) and underwent PCI along with CPET from November 1, 2015 to September 30, 2021 were enrolled. The patients were categorized into two groups based on PP: high PP group (PP of males ≥50 mmHg; PP of females ≥60 mmHg) and normal PP group (PP of males <50 mmHg; PP of females <60 mmHg). The primary endpoint was major adverse cardiovascular events (MACE). The optimal predictors of MACE were identified through Cox regression analysis. The time-dependent receiver operating characteristic (ROC) curves were generated and the area under the ROC curve (AUC) was measured to evaluate the discriminatory ability in patients with high PP.

Results: A total of 2785 patients were included in present study, with a median follow-up period of 1215 (687-1586) days. Through multifactorial analysis, it was determined that peak oxygen uptake (peak VO₂, hazard ratio (HR): 0.94, 95% confidence interval (95% CI): 0.88 to 1.00, p = 0.038) and ventilatory equivalent for carbon dioxide (VE/VCO₂, HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.007) are important predictive factors in the parameters of CPET. The ROC based on diabetes mellitus (DM), smoking, peak VO₂, and VE/VCO₂ could effectively evaluate the prognosis of patients [1-year AUC: 0.636 (0.515~0.758), 3-year AUC: 0.675 (0.599~0.752), 5-year AUC: 0.718 (0.607~0.830)].

Conclusions: The prognosis of CAD patients with high PP was worse compared to the patients with normal PP. The peak VO₂ and VE/VCO₂ were predictors of MACE in CAD patients with high PP.