Background: Pulse waveform characteristics (Augmentation Index – AIx, Pressure Augmentation – AP, Pulse wave transit time – Tr) as well as central pressure indices (aortic pulse pressure – aoPP, pulse pressure amplification – PPAmp, pulsatility – aortic PP/mean blood pressure) have been shown to predict cardiovascular events. We aimed to determine their relative predictive value.

Methods: We prospectively assessed AIx, AIx@75, AP, Tr as well as aoPP, PPAmp and pulsatility, using radial applanation tonometry and a validated transfer function, in 520 male patients undergoing coronary angiography. Primary endpoint was a composite of all cause mortality, myocardial infarction, stroke, cardiac, cerebrovascular and peripheral revascularization. Statistics used were Cox proportional hazards regression models.

Results: Mean age was 63 years, 66.7% were hypertensives, 79.2% had CAD. During a follow up of 49.4 months, 170 patients reached the primary endpoint.

All pressure waveform characteristics and central pressure indices predicted the primary endpoint: When divided into tertiles according to the various indices, patients in the first tertile had an unadjusted HR for the combined endpoint of 0.477 (0.328–0.727) for AIx, 0.492 (0.339–0.744) for AIx@75, 0.468 (0.314–0.698) for AP, 0.435 (0.302–0.647) for Tr, 0.468 (0.331–0.685) for aoPP, 0.586 (0.406–0.858) for PPAmp, and 0.585 (0.407–0.839) for pulsatility, when compared to patients in the third tertile. However, after adjustment for age, extent of coronary disease, and brachial blood pressures, only AIx, AIx@75, and Tr remained significant predictors of the combined endpoint.

Conclusion: In male patients undergoing coronary angiography, pulse waveform characteristics, but not central pressure indices, consistently and independently predict cardiovascular events.