New Indicator of Arterial Stiffness START-Is There a Prognostic Value of Its Dynamics in Patients with Coronary Artery Disease?

UNLABELLED: The aim of the study was to evaluate the prognostic value of the one-year dynamics of the new index START in patients with coronary artery disease after coronary artery bypass grafting (CABG).

METHODS

Patients with coronary artery disease (n = 196) whose START index was assessed before CABG and one year after surgery. Depending on the dynamics of the stiffness index, three groups of patients were identified: 1st-with a decrease in haSTART (n = 79, 40.3%), 2nd-without dynamics (n = 52, 26.5%), and 3rd. Patients were followed for 10 years, and groups were compared for all-cause death, myocardial infarction, stroke/transient ischemic attack, and a composite endpoint.

RESULTS

In the group with an increase in the haSTART index, type D personality was identified more often (53.8%) than in the group without changes in haSTAR (26.9%) or with a decrease in the haSTAR index (34.2%) (p = 0.008). In the long-term follow-up period, death from all causes was significantly more common in the group with an increase in haSTART (33.9%) and in the group without changes in haSTART (23.1%) than in the group with a decrease in haSTART (11.4%, p = 0.005). Patients with an increase in haSTART more often had MACE (death, MI, stroke/TIA)-in 47.7% of cases (p = 0.01), compared with patients with a decrease in haSTART (in 24.1% of cases) and without change in haSTART (by 30.8%). Kaplan-Meier curves revealed better long-term survival rates in the group with a decrease in the haSTART index (p = 0.024). Multivariate analysis showed that a decrease in the haSTART index one year after CABG was associated with a decrease in mortality (HR 0.462; 95% CI 0.210-1.016; p = 0.055).

CONCLUSIONS

The dynamics of the haSTART arterial stiffness index one year after CABG has prognostic significance in the long-term follow-up period. In addition, in the group with an increase in the haSTART index, personality type D is more common. Further studies need to study which interventions in patients with coronary artery disease can cause favorable dynamics in the haSTART index and to what extent psychological characteristics can influence these dynamics.