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CLINICAL RESEARCH

The Vital Prognosis of Subclavian Stenosis

Victor Aboyans, MD, PhD^_*,,_*, Michael H. Criqui, MD, MPH^_*,, Mary McGrae McDermott, MD, Matthew A. Allison, MD, MPH^_*, Julie O. Denenberg, MA^_*, Ramin Shadman, BA and Arnost Fronek, MD, PhD^||

^_* Department of Family and Preventive Medicine, University of California-San Diego, La Jolla, California
Department of Thoracic and Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France
Department of Medicine, University of California-San Diego, La Jolla, California
Northwestern University Feinberg School of Medicine, Chicago, Illinois
^|| Department of Surgery and Bio-Engineering, University of California-San Diego, La Jolla, California.

Manuscript received June 19, 2006; revised manuscript received August 21, 2006, accepted September 29, 2006.

^_* Reprint requests and correspondence: Dr. Victor Aboyans, Department of Family and Preventive Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, California 92093-0607. (Email: vaboyans{at}ucsd.edu).

Objectives: 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

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