This study sought to assess the prognosis of subclavian stenosis (SS) as a potential marker of total and cardiovascular disease (CVD) mortality.
Background
Subclavian stenosis, diagnosed by a brachial systolic pressure difference (BSPD) ≥15 mm Hg, is associated with an increased prevalence of CVD risk factors. However, the association between SS and mortality is unknown. We hypothesized that a BSPD ≥15 mm Hg would predict an increased risk of CVD events.
Methods
We analyzed baseline and longitudinal data from 3 cohorts. Two were recruited from noninvasive vascular laboratories, and the third was a community-dwelling cohort. Multivariate survival models were used to test for an independent association of SS with total and CVD mortality.
Results
Baseline and follow-up data (mean 9.8 years) were complete in 1,778 participants. Subclavian stenosis was found in 157 (8.8%) subjects. Adjusted for age, gender, ethnicity, and cohort of origin, the presence of SS was significantly associated with increased total and CVD mortality (respectively, hazard ratio [HR] 1.42, p < 0.005; and HR 1.50, p = 0.05). This association persisted after adjustments for CVD risk factors (smoking pack-years, hypertension, diabetes, total/high-density lipoprotein cholesterol ratio, and body mass index) as well as lipid-lowering and antiplatelet therapies (HR 1.40, p < 0.01; and HR 1.57, p < 0.05 for total and CVD mortality, respectively). When any history of CVD or an ankle-brachial index <0.90 were added to the model, SS remained an independent predictor for total mortality (HR 1.34, p = 0.02), with a similar trend for CVD mortality (HR 1.43, p = 0.09).
Conclusions
The presence of SS, easily diagnosed by comparing systolic pressures in the left and right arm, predicts total and CVD mortality independent of both CVD risk factors and existent CVD at baseline.
Abbreviations and Acronyms
ABI
ankle-brachial index
BSPD
brachial systolic pressure difference
CVD
cardiovascular disease
PAD
peripheral arterial disease
SBP
systolic blood pressure
SS
subclavian stenosis
Cited by (0)
This study was supported by NIH grants HL 22255 and HL 000946 (cohort A); grants R01-HL58099 and R01-HL64739 from the National Heart Lung and Blood Institute and grant RR-00048 from the National Center for Research Resources, National Institutes of Health (cohort B); and NIH grants HL 42973 as well as NCRR GCRC program grant M01 RR 00827 and AHA grant-in-aid 0050002N (cohort C). Michael Jaff, DO, FACC, acted as the Guest Editor for this article.